Policy Updates Prior AuthorizationMedicaidSeptember 1, 2024

Prior authorization changes for DME rentals

Anthem will be updating prior authorization requirements for durable medical equipment (DME) rentals.

Check prior authorization requirements

Please refer to the Precertification Lookup Tool for detailed information on prior authorization requirements:

  • Navigate to providers.anthem.com/nv.
  • Select Resources from top menu.
  • Select the Precertification Lookup Tool.
  • Enter the Line of Business, the code you are inquiring about, and select the Search button to find prior authorization/precertification requirements.

Request prior authorization

You can request prior authorizations directly in Availity:

  • Navigate to Availity.com.
  • Select Patient Registration from the top menu, then select Authorizations & Referrals, and finally select Authorization Request.

DME services

Effective October 1, 2024, rentals for DME services listed below will require prior authorization:

Procedure code

Procedure code description

E0143

Walker Folding Wheeled W/O S

E0149

Heavy Duty Wheeled Walker

E0165

COMMODE CHAIR, MOBILE OR STATIONARY, WITH DETACHABLE ARMS

E0168

Heavyduty/Wide Commode Chair

E0184

Dry Pressure Mattress

E0185

Gel Pressure Mattress Pad

E0186

Air Pressure Mattress

E0197

Air Pressure Pad For Mattress

E0202

Phototherapy Light W/ Photom

E0271

Mattress Innerspring

E0300

Pediatric crib, hospital grade, fully enclosed, with or without top enclosure

E0305

Rails Bed Side Half Length

E0310

Rails Bed Side Full Length

E0315

Bed Accessory Brd/Tbl/Supprt

E0424

Stationary Compressed Gas 02

E0434

Portable Liquid 02

E0439

Stationary Liquid 02

E0443

Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit

E0445

Oximeter Device For Measuring Blood Oxygen Levels Non-Invasively

E0465

Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube)

E0480

Percussor Elect/Pneum Home M

E0500

Ippb All Types

E0550

Humidif Extens Supple W Ippb

E0565

Compressor Air Power Source

E0570

Nebulizer With Compression

E0574

Ultrasonic Generator W Svneb

E0600

Suction Pump Portab Hom Modl

E0618

Apnea Monitor, Without Recording Feature

E0619

Apnea Monitor, With Recording Feature

E0621

Patient Lift Sling Or Seat

E0630

Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s), or pad(s)

E0651

Pneum Compressor Segmental

E0652

Pneum Compres W/Cal Pressure

E0668

Seg Pneumatic Appl Full Arm

E0671

Pressure Pneum Appl Full Leg

E0745

Neuromuscular Stim For Shock

E0776

Iv Pole

E0779

Amb Infusion Pump Mechanical

E0780

Mech Amb Infusion Pump < 8hrs

E0781

External Ambulatory Infus Pu

E0791

Parenteral Infusion Pump Sta

E0910

Trapeze Bar Attached To Bed

E0911

Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar

E0912

Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar

E0935

Continuous passive motion exercise device for use on knee only

E0940

Trapeze Bar Free Standing

E0951

Loop Heel

E0970

Wheelchair No. 2 Footplates

E0971

Manual wheelchair accessory, anti-tipping device, each

E0973

Wheelchair Adjustable Height

E0974

Wheelchair Grade-Aid

E0978

Wheelchair Belt W/Airplane B

E0990

Wheelchair Elevating Leg Res

E0994

Wheelchair Arm Rest

E1031

Rollabout Chair With Casters

E1060

Wheelchair Detachable Arms

E1070

Wheelchair Detachable Foot R

E1088

Wheelchair Lightweight Det A

E1092

Wheelchair Wide W/ Leg Rests

E1093

Wheelchair Wide W/ Foot Rest

E1100

Whchr S-Recl Fxd Arm Leg Res

E1130

Whlchr Stand Fxd Arm Ft Rest

E1140

Wheelchair Standard Detach A

E1150

Wheelchair Standard W/ Leg R

E1160

Wheelchair Fixed Arms

E1226

Wheelchair Spec Sz Full-Recl

E1240

Whchr Litwt Det Arm Leg Rest

E1260

Wheelchair Lightwt Foot Rest

E1280

Whchr H-Duty Det Arm Leg Res

E1290

Wheelchair Hvy Duty Detach A

E1355

Oxygen Supplies Stand/Rack

E1390

Oxygen Concentrator

E1639

Scale, for dialysis, each

E1700

Jaw Motion Rehab System

E1800

Adjust Elbow Ext/Flex Device

E1801

Static progressive stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes

E1805

Adjust Wrist Ext/Flex Device

E1810

Adjust Knee Ext/Flex Device

E1818

Static progressive stretch forearm pronation/supination device, with or without range of motion adjustment, includes all

E2601

Gen w/c cushion wdth < 22 in

E2602

Gen w/c cushion wdth >=22 in

E2620

WC planar back cush wd < 22in

K0001

Standard Wheelchair

K0002

Stnd Hemi (Low Seat) Whlchr

K0003

Lightweight Wheelchair

K0004

High Strength Ltwt Whlchr

K0006

Heavy Duty Wheelchair

K0053

Elevate Footrest Articulate

K0195

Elevating Whlchair Leg Rests

K0462

Temporary Replacement Eqpmnt

K0552

Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each

K0738

Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders, includes portable contai

Contact Us

For immediate assistance, contact Provider Services at 844-396-2330 or access Availity.com and chat with a live agent or send a secure message.

Anthem Blue Cross and Blue Shield Healthcare Solutions is the trade name of Community Care Health Plan of Nevada, Inc. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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PUBLICATIONS: September 2024 Provider Newsletter