Does E0635 require prior authorization?

Yes, E0635 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

`E0635`, Patient lift, electric with seat or sling

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 a Written Order Prior to Delivery (WOPD), the supplier must have received a signed WOPD before delivery; the WOPD must list the base item and may list separately billed associated options, accessories, or supplies.
Proof of delivery (POD) documentation must be maintained by the supplier and made available to the Medicare contractor upon request.
Claims must be correctly coded per CMS HCPCS guidelines, LCDs, LCD-related Policy Articles, or DME MAC articles to be reimbursed.

Item must be eligible for a defined Medicare benefit category to be covered.
Item must be reasonable and necessary for diagnosis or treatment of illness/injury or to improve functioning of a malformed body member (per SSA §1862(a)(1)(A)).
A patient lift is covered when transfer between bed and a chair, wheelchair, or commode is required and, without the use of a lift, the beneficiary would be bed confined.
HCPCS E0630, E0635, E0639, and E0640 are covered when the basic patient lift coverage criteria are met.
Multi-positional patient transfer systems (HCPCS E0636, E1035, E1036) are covered only if the basic lift coverage criteria are met and the beneficiary requires supine positioning for transfers.
HCPCS E0621 is covered as an accessory only when ordered as a replacement for a covered patient lift.

ANTHEM-CG-DME-23, Lifting Devices for Use in the Home

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

L33799, Patient Lifts

BCBSIL-DME101.034, Seat Lift Mechanisms and Patient Lifts

BCBSMT-DME101.034, Seat Lift Mechanisms and Patient Lifts

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