Does E0236 require prior authorization?

No, E0236 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

Backwork Sign up free

`E0236`, Pump for water circulating pad

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

Suppliers must maintain proof of delivery (POD) documentation in their files and make POD available to the Medicare contractor upon request.
A Standard Written Order (SWO) must be communicated to the supplier before claim submission; for DMEPOS base items requiring a Written Order Prior to Delivery (WOPD) the supplier must have a signed SWO/WOPD before delivery.
When a DMEPOS base item requires a WOPD and associated options/accessories/supplies are separately billed, the WOPD must list the base item and may list the separately billed associated items prior to delivery.
Suppliers and providers must follow the LCD-related Standard Documentation Requirements Article, the LCD-related Policy Article, the Supplier Manual, and DME MAC web publications for additional documentation and payment rules prior to reimbursement.

Key Coverage Criteria

An item is covered only if it is in a defined Medicare benefit category, is reasonable and necessary for diagnosis/treatment or to improve function of a malformed body member, and meets applicable Medicare statutory and regulatory requirements.
A standard electric heating pad (HCPCS E0210) is covered when used to relieve pain, decrease joint or soft tissue stiffness, relax muscles, or reduce inflammation.
ICD-10 G50.0: Trigeminal neuralgia (covered if selection criteria are met)
Use of CPT codes 64600 (destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch) and 64620 (destruction by neurolytic agent, intercostal nerve) when furnished for the indications listed in this CPB.
Selected ICD-10 diagnoses may be covered when selection criteria are met (examples listed in the CPB include G50.0 Trigeminal neuralgia; various joint effusion/hemarthrosis/pain codes; edema and swelling codes; pain codes), noting coverage is diagnosis- and criteria-dependent.
Cryoanalgesia for the temporary relief of pain due to chronic refractory trigeminal neuralgia (subject to Appendix selection criteria).

10 Active Policies

ANTHEM-DME.00037, Cooling Devices and Combined Cooling/Heating Devices

L33784, Heating Pads and Heat Lamps

AETNA-CPB-0297, Cryoanalgesia and Therapeutic Cold

AETNA-CPB-0540, Heating Devices

AMBETTER-CP.MP.107, Durable Medical Equipment and Orthotics and Prosthetics Guidelines

Have a follow-up question?

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

Ask Backwork about E0236 Sign up free

E0236, Pump for water circulating pad