Does E2394 require prior authorization?

Yes, E2394 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

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`E2394`, Power wheelchair accessory, drive wheel excludes tire, any size, replacement

HCPCS/CPT

Prior Authorization

Prior Auth Required

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

Documentation Required

A completed Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted for an item addressed in this policy.
For DMEPOS base items that require a Written Order Prior to Delivery (WOPD), the supplier must have received a signed WOPD before delivery; the WOPD may list associated separately billed options/accessories.
Proof of delivery (POD) documentation must be maintained by the supplier and made available to the Medicare contractor upon request.

Specialty evaluations required for certain items must be performed and documented by a licensed/certified PT, OT, or practitioner with specific training and experience in rehabilitation wheelchair evaluations and may not have a financial relationship with the supplier.

Key Coverage Criteria

Arm trough (E2209) is covered for beneficiaries with quadriplegia, hemiplegia, or uncontrolled arm movements.
Adjustable arm height option is covered if beneficiary requires an arm height different from available nonadjustable arms and spends at least 2 hours per day in the wheelchair.
Items are covered only if they are in a defined Medicare benefit category, are reasonable and necessary for diagnosis/treatment or to improve function of a malformed body member, and meet all other Medicare statutory/regulatory requirements.
Elevating legrests are covered if beneficiary has a musculoskeletal condition or a cast/brace preventing 90° knee flexion, or has significant lower-extremity edema requiring elevation, or meets criteria for and has a reclining back on the wheelchair.
Nonstandard manual wheelchair seat width and/or depth is covered only if the beneficiary's physical dimensions justify the need.
Gear reduction drive wheel (E2227) is covered if beneficiary has self-propelled a manual wheelchair for at least one year, has a specialty evaluation by a licensed/certified PT/OT or qualified practitioner documenting home need, and selection involved a supplier-employed RESNA-certified Assistive Technology Professional with direct in-person involvement.

7 Active Policies

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

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

L33792, Wheelchair Options/Accessories

BCBSIL-DME101.010, Wheelchairs and Accessories

BCBSMT-DME101.010, Wheelchairs and Accessories

BCBSNM-DME101.010, Wheelchairs and Accessories

BCBSOK-DME101.010, Wheelchairs and Accessories

`E2394`, Power wheelchair accessory, drive wheel excludes tire, any size, replacement

Prior Authorization

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

E2394, Power wheelchair accessory, drive wheel excludes tire, any size, replacement

Prior Authorization

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

`E2394`, Power wheelchair accessory, drive wheel excludes tire, any size, replacement