Does E1239 require prior authorization?

Yes, E1239 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

`E1239`, Power wheelchair, pediatric size, not otherwise specified

HCPCS/CPT

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Documentation demonstrating limitation of ambulation sufficient to require the device to accomplish ADLs in the home, school, or workplace.
Documentation showing inability to complete normal ADLs despite ability to walk short distances with assistive devices (crutches/cane) when that is the applicable scenario.
No documentation requirements are specified in this document excerpt.
No explicit documentation requirements are stated in the provided excerpt.

No explicit covered indications are provided in the supplied document excerpt. (Policy title indicates coverage pertains to mobility assistive devices — wheelchairs — for Humana Medicaid members in SC, but no diagnoses, clinical scenarios, or ICD-10 codes are listed in this excerpt.)
A wheelchair is a type of mobility assistive device that is considered durable medical equipment (DME).
Manual wheelchairs can be self-propelled or pushed by another individual.
A neurological or muscular disorder which limits ambulation to the point that the mobility assistive device must be used to accomplish the activities of daily living (ADL) in the home, school or workplace.
Individual is expected to grow in height.
Requires use with a ventilator which is mounted on the wheelchair.

HUMANA-MOBILITY-ASSISTIVE-DEVICES-WHEELCHAIRS-SC-MEDICAID, Mobility Assistive Devices (Wheelchairs)

HUMANA-MOBILITY-ASSISTIVE-DEVICES-WHEELCHAIRS-KY-MEDICAID, Mobility Assistive Devices (Wheelchairs)

ANTHEM-CG-DME-31, Powered Wheeled Mobility Devices

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

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