Does E0194 require prior authorization?

Yes, E0194 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

`E0194`, Air fluidized bed

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; claims submitted without a completed SWO shall be denied.
For DMEPOS base items that require a Written Order Prior to Delivery (WOPD), the supplier must have received a signed WOPD before delivery; delivery without a WOPD will result in denial.
When a WOPD is required and there are separately billed associated options/accessories/supplies, the WOPD must list the base item and may list the separately billed associated items prior to delivery.
The comprehensive assessment/evaluation and documentation that a one-month course of conservative treatment was performed without progression toward healing must be available (institution records acceptable to verify conservative treatment).

Beneficiary has a stage 3 (full thickness tissue loss) or stage 4 (deep tissue destruction) pressure ulcer.
Beneficiary is bedridden or chair-bound as a result of severely limited mobility.
In the absence of an air-fluidized bed, the beneficiary would require institutionalization.
Air-fluidized bed is ordered in writing by the treating practitioner based on a comprehensive assessment and evaluation after completion of a course of conservative treatment.
Comprehensive evaluation generally must be performed within one month prior to initiation of air-fluidized bed therapy.
A course of conservative treatment of at least one month duration without progression toward wound healing is required prior to ordering an air-fluidized bed.

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

L33692, Pressure Reducing Support Surfaces - Group 3

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