Does K1033 require prior authorization?

No, K1033 does not require prior authorization (high confidence). Covered without prior authorization.

`K1033`, Non-pneumatic sequential compression garment, half leg

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

Clinical documentation establishing that the equipment is necessary and reasonable and is expected to make a meaningful contribution to treatment or functional improvement.
Documentation that education regarding use of the device was provided and the member/caregiver demonstrated understanding.
Documentation of a trial of the requested device with evidence the member can use it safely and effectively.
Documentation that the patient has newly diagnosed nonischemic cardiomyopathy and is undergoing a trial of optimal medical therapy.

Single or multi-chamber or segmentnon-programmablecompression devices are consideredmedically necessarywhen the criteria below have been met:
Treatment of upper or lower limb lymphedema;and
The individualâs lymphedema is not improving;and
The individual has been compliant with conservative therapy*.
*Conservative therapy may include any combination of the following: elevation of the affected limb, exercise, massage, use of an appropriate compression bandage system or compression garment.
Single or multi-chamber or segmentprogrammable(for example, calibrated gradient pressure) compression devices are consideredmedically necessarywhen the criteria below have been met:

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

AMBETTER-CP.MP.107, Durable Medical Equipment and Orthotics and Prosthetics Guidelines

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