Does E1399 require prior authorization?

No, E1399 does not require prior authorization (low confidence). No active coverage policies found for this code.

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`E1399`, Durable medical equipment, miscellaneous

HCPCS/CPT

Prior Authorization

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Documentation Required

Documentation of clinical concern for symptomatic COVID-19 infection (e.g., symptoms consistent with COVID-19) when ordering molecular or antigen testing.
Documentation of known or suspected exposure to SARS-CoV-2 when that is part of the indication for testing.
Order must be placed and the test administered by a licensed or authorized healthcare provider (documentation of ordering provider and administration).
For antibody (serology) testing: documentation of prior molecular or antigen test results that were non-diagnostic, and documentation that the antibody test result will be used to aid in diagnosis of a condition related to COVID-19 (e.g., clinical notes supporting suspicion of MIS or post-acute sequelae).
When antibody testing is used to support diagnosis of MIS (MIS-A or MIS-C): clinical documentation consistent with MIS definitions (e.g., fever, multisystem involvement as listed in policy, hospitalization when applicable), laboratory evidence of inflammation (e.g., elevated CRP, ferritin, IL-6, ESR, procalcitonin), and evidence of current or recent SARS-CoV-2 infection by PCR, antigen, or serology as applicable (policy enumerates specific MIS laboratory and clinical criteria).
For high-throughput molecular/antigen tests: documentation that the performing laboratory is CLIA-certified as high-complexity when claiming coverage for such testing.

Key Coverage Criteria

Molecular or antigen in vitro diagnostic test for SARS-CoV-2 (COVID-19) infection when ALL of the following criteria are met: clinical concern for a symptomatic COVID-19 infection; individual with known or suspected exposure; ordered and administered by a licensed or authorized healthcare provider.
Antibody (serology) test for SARS-CoV-2 antibodies when: results of a molecular or antigen test is non-diagnostic for COVID-19 AND the results of the antibody test will be used to aid in the diagnosis of a condition related to COVID-19 infection (e.g., Multisystem Inflammatory Syndrome [MIS], post-acute sequelae).
Molecular/antigen tests (CPT/HCPCS listed in policy) billed with any diagnosis codes other than the specified non-covered screening/administrative codes are considered medically necessary when the above policy clinical criteria are met (policy notes 'All other codes').
Antibody (serology) testing (CPT codes listed under Antibody Testing) is considered medically necessary for diagnoses M35.81 (Multisystem inflammatory syndrome) and U09.9 (Post COVID-19 condition, unspecified) when applicable clinical criteria are met.
Replacement polycarbonate bottle for use with breast pump (HCPCS A4285).
Replacement locking ring for breast pump (HCPCS A4286).

20 Active Policies

CIGNA-0557, COVID-19: In Vitro Diagnostic Testing

HUMANA-MEDICAL-SUPPLIES-EQUIPMENT-AND-APPLIANCES-DURABLE-MEDICAL-EQUIPMENT-OK-MEDICAID, Medical Supplies, Equipment and Appliances Durable Medical Equipment

ANTHEM-DME.00011, Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices

ANTHEM-DME.00022, Functional Electrical Stimulation (FES); Threshold Electrical Stimulation (TES)

ANTHEM-DME.00050, Remote Devices for Intermittent Monitoring of Intraocular Pressure

ANTHEM-DME.00048, Virtual Reality-Assisted Therapy Systems

ANTHEM-DME.00047, Rehabilitative Devices with Remote Monitoring

ANTHEM-DME.00044, Robotic Arm Assistive Devices

ANTHEM-MED.00138, Wearable Devices for Stress Relief and Management

ANTHEM-MED.00130, Surface Electromyography and Electrodermal Activity Sensor Devices for Seizure Monitoring

ANTHEM-MED.00134, Non-invasive Heart Failure and Arrhythmia Management and Monitoring Systems

ANTHEM-DME.00037, Cooling Devices and Combined Cooling/Heating Devices

ANTHEM-DME.00038, Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices

ANTHEM-DME.00030, Altered Auditory Feedback Devices for Fluency Disorders

ANTHEM-CG-DME-30, Prothrombin Time Self-Monitoring Devices

ANTHEM-CG-DME-35, Electric Breast Pumps

ANTHEM-CG-DME-06, Compression Devices for Lymphedema

ANTHEM-CG-MED-28, Iontophoresis

ANTHEM-CG-DME-39, Dynamic Low-Load Prolonged-Duration Stretch Devices

SUREST-POL-SUREST-beds-mattresses-sur, Beds and Mattresses – Surest Medical Policy

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E1399, Durable medical equipment, miscellaneous

HCPCS/CPT

Prior Authorization

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Documentation Required

Documentation of clinical concern for symptomatic COVID-19 infection (e.g., symptoms consistent with COVID-19) when ordering molecular or antigen testing.
Documentation of known or suspected exposure to SARS-CoV-2 when that is part of the indication for testing.
Order must be placed and the test administered by a licensed or authorized healthcare provider (documentation of ordering provider and administration).
For antibody (serology) testing: documentation of prior molecular or antigen test results that were non-diagnostic, and documentation that the antibody test result will be used to aid in diagnosis of a condition related to COVID-19 (e.g., clinical notes supporting suspicion of MIS or post-acute sequelae).
When antibody testing is used to support diagnosis of MIS (MIS-A or MIS-C): clinical documentation consistent with MIS definitions (e.g., fever, multisystem involvement as listed in policy, hospitalization when applicable), laboratory evidence of inflammation (e.g., elevated CRP, ferritin, IL-6, ESR, procalcitonin), and evidence of current or recent SARS-CoV-2 infection by PCR, antigen, or serology as applicable (policy enumerates specific MIS laboratory and clinical criteria).
For high-throughput molecular/antigen tests: documentation that the performing laboratory is CLIA-certified as high-complexity when claiming coverage for such testing.

Key Coverage Criteria

Molecular or antigen in vitro diagnostic test for SARS-CoV-2 (COVID-19) infection when ALL of the following criteria are met: clinical concern for a symptomatic COVID-19 infection; individual with known or suspected exposure; ordered and administered by a licensed or authorized healthcare provider.
Antibody (serology) test for SARS-CoV-2 antibodies when: results of a molecular or antigen test is non-diagnostic for COVID-19 AND the results of the antibody test will be used to aid in the diagnosis of a condition related to COVID-19 infection (e.g., Multisystem Inflammatory Syndrome [MIS], post-acute sequelae).
Molecular/antigen tests (CPT/HCPCS listed in policy) billed with any diagnosis codes other than the specified non-covered screening/administrative codes are considered medically necessary when the above policy clinical criteria are met (policy notes 'All other codes').
Antibody (serology) testing (CPT codes listed under Antibody Testing) is considered medically necessary for diagnoses M35.81 (Multisystem inflammatory syndrome) and U09.9 (Post COVID-19 condition, unspecified) when applicable clinical criteria are met.
Replacement polycarbonate bottle for use with breast pump (HCPCS A4285).
Replacement locking ring for breast pump (HCPCS A4286).

20 Active Policies

CIGNA-0557, COVID-19: In Vitro Diagnostic Testing

HUMANA-MEDICAL-SUPPLIES-EQUIPMENT-AND-APPLIANCES-DURABLE-MEDICAL-EQUIPMENT-OK-MEDICAID, Medical Supplies, Equipment and Appliances Durable Medical Equipment

ANTHEM-DME.00011, Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices

ANTHEM-DME.00022, Functional Electrical Stimulation (FES); Threshold Electrical Stimulation (TES)

ANTHEM-DME.00050, Remote Devices for Intermittent Monitoring of Intraocular Pressure

ANTHEM-DME.00048, Virtual Reality-Assisted Therapy Systems

ANTHEM-DME.00047, Rehabilitative Devices with Remote Monitoring

ANTHEM-DME.00044, Robotic Arm Assistive Devices

ANTHEM-MED.00138, Wearable Devices for Stress Relief and Management

ANTHEM-MED.00130, Surface Electromyography and Electrodermal Activity Sensor Devices for Seizure Monitoring

ANTHEM-MED.00134, Non-invasive Heart Failure and Arrhythmia Management and Monitoring Systems

ANTHEM-DME.00037, Cooling Devices and Combined Cooling/Heating Devices

ANTHEM-DME.00038, Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices

ANTHEM-DME.00030, Altered Auditory Feedback Devices for Fluency Disorders

ANTHEM-CG-DME-30, Prothrombin Time Self-Monitoring Devices

ANTHEM-CG-DME-35, Electric Breast Pumps

ANTHEM-CG-DME-06, Compression Devices for Lymphedema

ANTHEM-CG-MED-28, Iontophoresis

ANTHEM-CG-DME-39, Dynamic Low-Load Prolonged-Duration Stretch Devices

SUREST-POL-SUREST-beds-mattresses-sur, Beds and Mattresses – Surest Medical Policy

Have a follow-up question?

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

Ask Backwork about E1399 Sign up free

`E1399`, Durable medical equipment, miscellaneous

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`E1399`, Durable medical equipment, miscellaneous

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

E1399, Durable medical equipment, miscellaneous

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

E1399, Durable medical equipment, miscellaneous

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`E1399`, Durable medical equipment, miscellaneous

`E1399`, Durable medical equipment, miscellaneous