Does E0856 require prior authorization?

No, E0856 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

`E0856`, Cervical traction device, with inflatable air bladder(s)

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

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted for covered items.
For DMEPOS base items requiring a Written Order Prior to Delivery (WOPD), the supplier must have a signed WOPD before delivery; the WOPD should list the base item and may list separately billed associated options/accessories/supplies.
Suppliers must maintain proof of delivery (POD) documentation and make it available to the Medicare contractor upon request.

It is expected that the patient’s medical records will reflect the need for the care provided. The patient’s medical records include the physician’s office records, hospital records, nursing home records, home health agency records, records from other healthcare professionals and test reports. This documentation must be available upon request.

Key Coverage Criteria

HCPCS E0849 or E0855 (chin halter variants) are covered when the general coverage criteria are met and the beneficiary has a diagnosis of temporomandibular joint (TMJ) dysfunction with prior treatment for the TMJ condition.
Cervical traction devices (E0840, E0849, E0850, E0855, E0860) are covered only if the beneficiary has a musculoskeletal or neurologic impairment that requires traction equipment.
Coverage requires that the appropriate use of the home cervical traction device has been demonstrated to the beneficiary and the beneficiary tolerated the selected device.
HCPCS E0860 (over-the-door cervical traction mechanism) is covered when the general coverage criteria (impairment requiring traction and device demonstration/tolerance) are met.
HCPCS E0849 or E0855 are covered when the general coverage criteria are met and the beneficiary has distortion of the lower jaw or neck anatomy (e.g., radical neck dissection) such that a chin halter cannot be utilized.
HCPCS E0849 or E0855 are covered when the general coverage criteria are met and the treating practitioner documents medical necessity for greater than 20 pounds of cervical traction in the home setting.

7 Active Policies

ANTHEM-CG-DME-05, Cervical Traction Devices for Home Use

L33823, Cervical Traction Devices

UHC-POL-home-traction-therapy, Home Traction Therapy

AETNA-CPB-0453, Cervical Traction Devices

UMR-POL-UMR-home-traction-therapy, Home Traction Therapy

SUREST-POL-SUREST-home-traction-therapy, Home Traction Therapy

CIGNA-CPG265, Home Traction Devices - Cervical and Lumbar

`E0856`, Cervical traction device, with inflatable air bladder(s)

Prior Authorization

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

E0856, Cervical traction device, with inflatable air bladder(s)

Prior Authorization

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

`E0856`, Cervical traction device, with inflatable air bladder(s)