Does E1298 require prior authorization?

No, E1298 does not require prior authorization (high confidence). Covered without prior authorization.

`E1298`, Special wheelchair seat depth and/or width, by construction

HCPCS/CPT

No Prior Auth Required

Covered without 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)

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

BCBSIL-DME101.010, Wheelchairs and Accessories

BCBSMT-DME101.010, Wheelchairs and Accessories

BCBSNM-DME101.010, Wheelchairs and Accessories

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