Does E0193 require prior authorization?

Yes, E0193 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

`E0193`, Powered air flotation bed (low air loss therapy)

HCPCS/CPT

Prior Auth Required

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

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted; for DMEPOS base items requiring WOPD, a signed WOPD must be received before delivery.
For DMEPOS base items with separately billed options/accessories, the WOPD must list the base item and may list associated separately billed options/accessories prior to delivery.
When a beneficiary is on a group 2 surface, there should be a care plan established by the treating practitioner or home care nurse that documents the comprehensive ulcer treatment program elements (group 1 surface use, regular assessment, turning/positioning, wound care, moisture/incontinence management, nutritional assessment/intervention).
Suppliers must maintain adequate ongoing communication with the clinician providing wound care and retain medical record documentation supporting use of the KX modifier; this documentation should not be submitted with the claim but must be available upon request.

Beneficiary has multiple stage 2 pressure ulcers on the trunk or pelvis that have failed to improve over the past 1 month while on a comprehensive ulcer treatment program that includes a group 1 support surface, regular clinician assessment, turning/positioning, wound care, moisture/incontinence management, and nutritional assessment/intervention.
Beneficiary has a large or multiple stage 3 or stage 4 pressure ulcer(s) on the trunk or pelvis.
Beneficiary had a myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis within the past 60 days and was on a group 2 or group 3 support surface immediately prior to discharge from a hospital or nursing facility within the past 30 days.
Continued use of a group 2 support surface is covered until the ulcer is healed or, if healing is not continuing, when medical record documentation shows that other care plan aspects are being modified to promote healing or that continued group 2 use is reasonable and necessary for wound management.
The provided support surface must be one in which the beneficiary does not 'bottom out' and must meet the characteristics specified in the Policy Article coding guidelines.
Covered as DME when a safety enclosure with beds is required due to cognitive impairment or severe behavioral disorder, medications for seizures/behaviors are optimized or not appropriate, and a safety risk is present (e.g., claustrophobia, high fall risk, uncontrolled movements, violent or self-destructive behaviors).

SUREST-POL-SUREST-beds-mattresses-sur, Beds and Mattresses – Surest Medical Policy

ANTHEM-CG-DME-16, Pressure Reducing Support Surfaces - Groups 1, 2 & 3

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

L33642, Pressure Reducing Support Surfaces - Group 2

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