Does K1036 require prior authorization?

No, K1036 does not require prior authorization (high confidence). Code is covered without prior authorization.

`K1036`, Supplies and accessories (e.g., transducer) for low frequency ultrasonic

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Review and include the member's benefit contract or Summary Plan Description (SPD) when making coverage determinations.
Use only the written coverage position in the Medical Policy for benefit determinations; do not rely on the presence or absence of codes in the document.

Illinois-only: For group or individual fully insured PPO, HMO, POS plans amended, delivered, issued, or renewed on or after 2025-01-01, cover therapy, diagnostic testing, and equipment necessary to increase quality of life for children clinically or genetically diagnosed with a disease/syndrome/disorder that includes low tone neuromuscular impairment, neurological impairment, or cognitive impairment.
Noninvasive therapeutic ultrasound for treatment of musculoskeletal conditions to promote soft-tissue healing and provide pain relief.
Ultrasonic diathermy (therapeutic ultrasound) to produce therapeutic heat in collagen‑rich tissues (muscles, tendons, ligaments) to facilitate soft tissue injury repair.
Home-based continuous low-intensity therapeutic ultrasound (sustained acoustic medicine) for delivery of diathermy
Alleviation of pain through deep heating of body tissues
Treatment of muscle spasms

BCBSIL-THE801.039, Stationary Ultrasonic Diathermy Devices

BCBSMT-THE801.039, Stationary Ultrasonic Diathermy Devices

BCBSNM-THE801.039, Stationary Ultrasonic Diathermy Devices

BCBSOK-THE801.039, Stationary Ultrasonic Diathermy Devices

THE801.039, Stationary Ultrasonic Diathermy Devices

Ask Verity about documentation requirements, denial risks, or coverage in your state.