Does E1296 require prior authorization?

No, E1296 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`E1296`, Special wheelchair seat height from floor

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

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.

Key Coverage Criteria

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.

7 Active Policies

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

ANTHEM-SURG.00111, Axial Lumbar Interbody Fusion

ANTHEM-CG-DME-34, Wheeled Mobility Devices: Wheelchair Accessories

BCBSIL-DME101.010, Wheelchairs and Accessories

BCBSMT-DME101.010, Wheelchairs and Accessories

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E1296, Special wheelchair seat height from floor