HealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsDecember 1, 2021
Change to durable medical equipment wheelchair benefit limits
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.
PUBLICATIONS: December 2021 Anthem Provider News - Virginia
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