Does E0617 require prior authorization?

Yes, E0617 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

`E0617`, External defibrillator with integrated electrocardiogram analysis

HCPCS/CPT

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

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.

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.

HUMANA-CARDIAC-DEVICES-VA-MEDICAID, Cardiac Devices

HUMANA-CARDIAC-DEVICES-OH-MEDICAID, Cardiac Devices

ANTHEM-CG-DME-55, Automated External Defibrillators for Home Use

CIGNA-0431, Cardioverter-Defibrillator Devices

L33690

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