Please note, this communication applies to Anthem HealthKeepers Plus, Medallion and Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) offered by HealthKeepers, Inc.

 

Effective January 1, 2022, HealthKeepers, Inc. will align the benefit limits for wheelchairs and accessories with Virginia Department of Medical Assistance Services (DMAS) benefit limits. The list of impacted codes is noted below. This change will affect the current reimbursement policy and related claims processing rules associated with wheelchairs and accessories.

 

HealthKeepers, Inc. will no longer reimburse for any supply amount that exceeds the DMAS benefit limits for Anthem HealthKeepers Plus members.

 

HealthKeepers, Inc. will only reimburse providers for quantities exceeding DMAS limits when prescribed by a physician, documented on a Certificate of Medical Necessity, and authorized by HealthKeepers, Inc. HealthKeepers, Inc. follows the same criteria as DMAS in determining all medical necessity approval.

 

We recommend that providers visit the online Provider Manual to review all authorizations, appeals, and reconsideration processes at:
https://providers.anthem.com/docs/gpp/VA_CAID_ProviderManual.pdf?v=202105212022.

 

 

CODE

DESCRIPTION

DMAS LIMIT

E2630

Wheelchair accessory, shoulder elbow, mobile arm support monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support

2/24 months

E2631

Wheelchair accessory, addition to mobile arm support, elevating proximal arm

2/24 months

E2632

Wheelchair accessory, addition to mobile arm support, offset or lateral rocker

2/24 months

E2633

Wheelchair accessory, addition to mobile arm support, supinator

2/24 months

E0953

Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each

2/24 months

E0954

Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot

2/24 months

E0970

No. 2 footplates, except for elevating leg rests

2/60 months

E0990

Wheelchair accessory, elevating leg rest, complete assembly, each

2/60 months

K0037

High mount flip-up footrest, each

2/60 months

K0038

Leg strap, each

2/24 months

K0039

Leg strap, H style, each

2/24 months

K0040

Adjustable angle footplate, each

2/60 months

K0041

Large size footplate, each

2/60 months

K0042

Standard size footplate, replacement only, each

2/60 months

K0050

Ratchet assembly, replacement only

2/36 months

K0051

Cam release assembly, footrest or leg rest, replacement only, each

2/36 months

K0195

Elevating leg rest, pair

1/36 months

E0956

Wheelchair accessory, lateral trunk or hip support, prefabricated, including fixed mounting hardware

2/36 months

E0980

Safety vest, wheelchair

1/60 months

E0950

Wheelchair accessory, tray, each

1/60 months

E2326

Power wheelchair accessory, breathe tube kit for sip and puff interface

1/60 months

E1014

Reclining back, addition to pediatric size wheelchair

1/60 months

E1226

Fully reclining back, for customized wheelchair

1/60 months

E2211

Manual wheelchair accessory, pneumatic propulsion tire, any size, each

2/24 months

E2212

Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each

2/24 months

E2213

Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each

2/24 months

E2214

Manual wheelchair accessory, pneumatic caster tire, any size, each

2/24 months

E2215

Manual wheelchair accessory, tube for pneumatic caster tire, any size, each

2/24 months

E2216

Manual wheelchair accessory, foam filled propulsion tire, any size, each

2/24 months

E2217

Manual wheelchair accessory, foam filled caster tire, any size, each

2/24 months

E2218

Manual wheelchair accessory, foam propulsion tire, any size, each

2/24 months

E2219

Manual wheelchair accessory, foam caster tire, any size, each

2/24 months

E2220

Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each

2/24 months

E2221

Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each

2/24 months

E2222

Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each

2/24 months

E2224

Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each

2/24 months

E2225

Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each

2/24 months

E2226

Manual wheelchair accessory, caster fork, any size, replacement only, each

2/24 months

E2227

Manual wheelchair accessory, gear reduction drive wheel, each

2/24 months

E2381

Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each

2/24 months

E2382

Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each

2/24 months

E2383

Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each

2/24 months

E2384

Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each

2/24 months

E2385

Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each

2/24 months

E2386

Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each

2/24 months

E2387

Power wheelchair accessory, foam filled caster tire, any size, replacement only, each

2/24 months

E2388

Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each

2/24 months

E2389

Power wheelchair accessory, foam caster tire, any size, replacement only, each

2/24 months

E2390

Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each

2/24 months

E2391

Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each

2/24 months

E2392

Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each

2/24 months

E2394

Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each

2/24 months

E2395

Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each

2/24 months

E2396

Power wheelchair accessory, caster fork, any size, replacement only, each

2/24 months

K0065

Spoke protectors, each

2/24 months

E1015

Shock absorber for manual wheelchair, each

2/24 months

E1016

Shock absorber for power wheelchair, each

2/24 months

E1017

Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each

2/24 months

E1018

Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each

2/24 months

E1028

Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory

1/36 months

E0958

Manual wheelchair accessory, one-arm drive attachment

1/60 months

E0959

Manual wheelchair accessory, adapter for amputee

1/60 months

E0967

Manual wheelchair accessory, hand rim with projections, any type, replacement only, each

2/60 months

E0969

Narrowing devices, wheelchair

1/60 months

E0986

Manual wheelchair accessory, push activated power assist, each

1/60 months

E0988

Manual wheelchair accessory, lever-activated, wheel drive, pair

1/60 months

E1011

Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair)

1/60 months

E2207

Wheelchair accessory, crutch and cane holder, each

1/60 months

E2208

Wheelchair accessory, cylinder tank carrier, each

1/60 months

E2210

Wheelchair accessory, bearings, any type, replacement only, each

1/60 months

K0105

IV hanger, each

1/60 months

K0098

Drive belt for power wheelchair, replacement only

1/36months

E2368

Power wheelchair component, drive wheel motor, replacement only

2/36 months

E2369

Power wheelchair component, drive wheel, gear box, replacement only

2/36 months

E2378

Power wheelchair component, actuator, replacement only

1/36 month

 

If you have any questions about this communication, call Anthem HealthKeepers Plus, Medallion Provider Services at 800‑901‑0020 or Anthem CCC Plus Provider Services at 855‑323‑4687.

 

AVAPEC-3224-21



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December 2021 Anthem Provider News - Virginia