Does A9999 require prior authorization?

Yes, A9999 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for A9999?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`A9999`, Miscellaneous dme supply or accessory, not otherwise specified

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

A completed Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted for the item; absence of a completed SWO will result in claim denial.
For DMEPOS base items requiring Written Order Prior to Delivery (WOPD), the supplier must have a signed WOPD before item delivery; WOPD must list the base item and may list separately billed associated options, accessories, and supplies.

Suppliers are required to maintain proof of delivery (POD) documentation and make POD available to the Medicare contractor upon request.

Treating practitioner providing the order is expected to be experienced in the management of beneficiaries at risk for sudden cardiac death.

Claims must meet applicable coding guidelines (CMS HCPCS, LCDs, LCD-related Policy Articles, and DME MAC articles); refer to the LCD-related Standard Documentation Requirements Article and LCD-related Policy Article for details.

Suppliers must maintain proof of delivery (POD) documentation in their files and make POD available to the Medicare contractor upon request.

Key Coverage Criteria

Automatic external defibrillators (wearable K0606 or nonwearable E0617) are covered for beneficiaries at high risk for sudden cardiac death (SCD) when they meet one of the specific clinical criteria below.
Wearable defibrillator (K0606) covered for beneficiaries with a documented episode of ventricular fibrillation or a sustained ventricular tachyarrhythmia lasting ≥30 seconds that is not due to a transient or reversible cause and does not occur during the first 48 hours of an acute myocardial infarction.
Wearable defibrillator (K0606) covered for beneficiaries with familial or inherited conditions conferring high risk of life‑threatening ventricular tachyarrhythmias (e.g., long QT syndrome or hypertrophic cardiomyopathy).
Wearable defibrillator (K0606) covered for beneficiaries with documented prior myocardial infarction or dilated cardiomyopathy and measured left ventricular ejection fraction (LVEF) ≤ 0.35.
Wearable defibrillator (K0606) covered when a previously implanted defibrillator requires explantation.
Nonwearable automatic defibrillator (E0617) covered for beneficiaries with documented cardiac arrest due to ventricular fibrillation not caused by a transient or reversible condition.

6 Active Policies

ANTHEM-MED.00143, Ingestible Devices for the Treatment of Constipation

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

L33690, Automatic External Defibrillators

L33784, Heating Pads and Heat Lamps

L33822, Glucose Monitors

REGENCE-DME77, Insulin Infusion Pumps, Automated Insulin Delivery and Artificial Pancreas Device Systems

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A9999, Miscellaneous dme supply or accessory, not otherwise specified