Does E0468 require prior authorization?

Yes, E0468 requires prior authorization (high confidence). Code explicitly requires prior authorization.

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`E0468`, Home ventilator, dual-function respiratory device, also performs additional

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Documentation Required

Prescription/order from a health care practitioner authorizing the DME item.
No explicit documentation requirements are stated in this section of the policy.
Prescription by a health care provider (explicit: items are 'prescribed by a health care provider').
Documentation that the item is for long-term and/or everyday use in the home (implicit requirement based on definition).

Key Coverage Criteria

Replacement polycarbonate bottle for use with breast pump (HCPCS A4285).
Replacement locking ring for breast pump (HCPCS A4286).
Disposable collection and storage bag for breast milk, any size, any type, each (HCPCS A4287).
E0910 - Trapeze bars, also known as Patient Helper, attached to bed, with grab bar
Durable medical equipment (DME), also known as home medical equipment (HME), refers to nondisposable devices prescribed by a health care provider for long-term and/or everyday use in the home.
It must provide therapeutic benefits or enable the individual to perform certain tasks that they would be unable to perform or otherwise undertake due to certain medical conditions or illnesses.

7 Active Policies

HUMANA-MEDICAL-SUPPLIES-EQUIPMENT-AND-APPLIANCES-DURABLE-MEDICAL-EQUIPMENT-OK-MEDICAID, Medical Supplies, Equipment and Appliances Durable Medical Equipment

ANTHEM-CG-DME-47, Noninvasive Home Ventilator Therapy for Respiratory Failure

ANTHEM-CG-DME-26, Back-Up Ventilators in the Home Setting

EVICORE-HPLAN-CIGNA-3C6BF790C032, Cigna Commercial DME Code List - Effective 03/07/2026

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E0468, Home ventilator, dual-function respiratory device, also performs additional