Does Q74.3 require prior authorization?

No, Q74.3 does not require prior authorization (high confidence). Covered without prior authorization.

`Q74.3`, Arthrogryposis multiplex congenita

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical record documentation that the member has a mobility limitation that significantly impairs his/her ability to participate in one or more MRADL in the home (MRADLs defined as toileting, feeding, dressing, grooming, and bathing performed in customary locations in the home).
Documentation that the mobility limitation: prevents the member from accomplishing the MRADL entirely; or places the member at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform an MRADL; or prevents the member from completing the MRADL within a reasonable time frame.
Documentation that the member is able to safely use the requested cane, crutch or walker.
Documentation that the functional mobility deficit can be sufficiently resolved by use of the requested cane, crutch or walker.

Canes, quad canes, and crutches are medically necessary if all of the following criteria are met: The member has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living (MRADL) in the home (toileting, feeding, dressing, grooming, and bathing); the member is able to safely use the cane or crutch; and the functional mobility deficit can be sufficiently resolved by use of a cane or crutch.
Standard walker and related accessories are medically necessary if all of the following criteria are met: The member has a mobility limitation that significantly impairs his/her ability to participate in one or more MRADL in the home; the member is able to safely use the walker; and the functional mobility deficit can be sufficiently resolved with use of a walker.
A standard walker may include wheels and glide-type brakes (wheeled walker = 2, 3, or 4 wheels; wheels may be fixed or swivel; fixed height or adjustable height; may or may not include glide-type brakes).
Pediatric crawlers as DME for disabled children.
The Mulholland Walkabout as DME for children who have impaired ambulation and who lack trunk stability and balance.
Prone, supine and upright (floor/mobile) standers (e.g., Rifton Supine, Prone or Dynamic; Squiggles) as DME for children with cerebral palsy or other severe neuromuscular conditions.

AMBETTER-CP.MP.99, Wheelchair Seating

CIGNA-0069, Airway Clearance Devices in the Ambulatory Setting

AETNA-CPB-0271, Wheelchairs and Power Operated Vehicles (Scooters)

AETNA-CPB-0505, Ambulatory Assist Devices: Walkers, Canes, and Crutches

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