Does S5165 require prior authorization?

No, S5165 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for S5165?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Home inspection is required to document the environment supports operation of the wheelchair and to evaluate member's ability to operate equipment.
Provider must submit the Wheelchair Medical Necessity and Home Evaluation Verification form as documentation.

Patient must weigh 250 lbs. or less for PAPAW eligibility.
Home inspection to determine the home environment supports unhindered operation of the wheelchair and to evaluate the member's ability to safely operate the equipment.
Provider must fill out and submit the "Wheelchair Medical Necessity and Home Evaluation Verification" form.
Only one wheelchair may be rented or, if less costly, purchased at a time.
Patient has a mobility limitation that significantly impairs participation in one or more MRADLs within the home.
Mobility limitation cannot be sufficiently resolved by an appropriately fitted cane or walker.

BCBSIL-DME101.010, Wheelchairs and Accessories

BCBSMT-DME101.010, Wheelchairs and Accessories

BCBSNM-DME101.010, Wheelchairs and Accessories

BCBSOK-DME101.010, Wheelchairs and Accessories

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