(DME), Prosthetics and Orthotics HCPCS Codes That Require Precertification

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(DME), Prosthetics and Orthotics HCPCS Codes That Require Precertification Durable Medical Equipment (DME), Prosthetics and Orthotics HCPCS codes that require precertification. ************************************************************************************************************************** Please note that this list is not inclusive of all of the HCPCS codes that require precertification because of the $500 Allowance RULE which applies to DME, orthotics, equipment and supplies. However, codes list require precertification regardless of $500 RULE. HCPCS QUEST Description A9274 X External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories A9277 X Transmitter, external, for use with interstitial continuous glucose monitoring system A9278 X Receiver (monitor); external, for use with interstitial continuous glucose monitoring system A9900 X Misc. DME supply, accessory, and/or service component of another HCPCS code A9999 X Misc. DME supply or accessory, not otherwise specific E0181 X Powered pressure reducing mattress overly/pad, alternating, with pump, includes heavy duty E0182 X Pump for alternating pressure pad, for replacement only E0184 X Dry pressure mattress E0185 X Gel or gel-like pressure pad for mattress, standard mattress length and width E0186 X Air pressure mattress E0187 X Water pressure mattress E0188 X Synthetic sheepskin pad E0189 X Lambswool sheepskin pad, any size E0193 X Powered air flotation bed (low air loss therapy) E0194 X Air fluidized bed E0196 X Gel pressure mattress E0197 X Air pressure pad for mattress, standard mattress length and width E0198 X Water pressure pad for mattress, standard mattress length and width E0199 X Dry pressure pad for mattress, standard mattress length and width E0250 X Hospital bed, fixed height, with any type of side rails, with mattress E0251 X Hospital bed, fixed height, with any type side rails, without mattress E0255 X Hospital bed, variable height, hi-lo, with any type side rails, with mattress E0256 X Hospital bed, variable height, hi-lo, with any type side rails, without mattress E0260 X Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress E0261 X Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress E0265 X Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress E0266 X Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress E0290 X Hospital bed, fixed height, without side rails, with mattress E0291 X Hospital bed, fixed height, without side rails, without mattress Durable Medical Equipment (DME), Prosthetics and Orthotics HCPCS codes that require precertification. ************************************************************************************************************************** Please note that this list is not inclusive of all of the HCPCS codes that require precertification because of the $500 Allowance RULE which applies to DME, orthotics, equipment and supplies. However, codes list require precertification regardless of $500 RULE. HCPCS QUEST Description E0292 X Hospital bed, variable height, hi-lo, without side rails, with mattress E0293 X Hospital bed, variable height, hi-lo, without side rails, without mattress E0294 X Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress E0295 X Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress E0296 X Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress E0297 X Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with E0301 X any type side rails, without mattress Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without E0302 X mattress Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds but less than or equal to 600 pounds, with E0303 X any type side rails, with mattress Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with E0304 X mattress Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above E0328 X the spring, includes mattress Hospital bed, pediatric, electric or semi-electric, manual, 360 degree side enclosures, top of headboard, footboard and side E0329 X rails up to 24 inches above the spring, includes mattress E0371 X Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width E0372 X Powered air overlay for mattress, standard mattress length and width E0373 X Nonpowered advanced pressure reducing mattress Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, E0424 X nebulizer, cannula or mask, and tubing Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and E0431 X tubing Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, E0434 X contents gauge, cannula or mask, and tubing Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or E0439 X mask, and tubing E0445 X Oximeter device for measuring blood oxygen levels non-invasively Durable Medical Equipment (DME), Prosthetics and Orthotics HCPCS codes that require precertification. ************************************************************************************************************************** Please note that this list is not inclusive of all of the HCPCS codes that require precertification because of the $500 Allowance RULE which applies to DME, orthotics, equipment and supplies. However, codes list require precertification regardless of $500 RULE. HCPCS QUEST Description Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal E0470 X or facial mask (intermittent assist device with continuous positive airway pressure device) Respiratory assist device, bi-level pressure capability, backup rate feature, used with noninvasive interface, e.g., nasal or facial E0471 X mask (intermittent assist device with continuous positive airway pressure device) High frequency chest wall oscillation air-pulse generator system, (including hoses and vest), each E0483 X Oscillatory Device for Bronchial Drainage (The Vest) Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting E0485 X and adjustment Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes E0486 X fitting and adjustment E0601 X Continuous positive airway pressure (CPAP) device E0618 X Apnea monitor, without recording feature E0619 X Apnea monitor, with recording feature E0625 X Patient lift, bathroom or toilet, not otherwise classifies E0637 X Combination sit-to-stand frame/table system, any size including pediatric, with seat lift feature, with or without wheels X Standing frame/table system, one position (e.g., upright, supine or prone stander), any size including pediatric, with or without E0638 wheels E0641 X Standing frame/table system, multi-position (e.g., 3-way stander), any size including pediatric, with or without wheels E0642 X Standing frame/table system, mobile (dynamic stander), any size including pediatric E0650 X Pneumatic Compressor, non-segmental home model E0651 X Pneumatic compressor, segmental home model without calibrated gradient pressure E0652 X Pneumatic Compressor, Segmental Home Model with calibrated gradient pressure Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral E0675 X system) E0676 X Intermittent Limb Compression device (includes all accessories), not otherwise specified E0720 X TENS, two lead, localized stimulation E0730 X TENS, four or more leads, for multiple nerve stimulation Form-fitting conductive garment for delivery of TENS or NMES (with conductive fibers separated from the patient’s skin by E0731 X layers of fabric) E0747 X Osteogenesis stimulator, electrical, noninvasive, other than spinal applications Durable Medical Equipment (DME), Prosthetics and Orthotics HCPCS codes that require precertification. ************************************************************************************************************************** Please note that this list is not inclusive of all of the HCPCS codes that require precertification because of the $500 Allowance RULE which applies to DME, orthotics, equipment and supplies. However, codes list require precertification regardless of $500 RULE. HCPCS QUEST Description E0748 X Osteogenesis stimulator, electrical, noninvasive, spinal applications E0760 X Osteogenesis stimulator, low intensity ultrasound, noninvasive E0762 X Transcutaneous electrical joint stimulation device system, includes all accessories Functional neuromuscular stimulation, transcutaneous stimulation of sequential muscle groups of ambulation with computer E0764 X control, used for walking by spinal cord injured, entire system, after completion of training program E0784 X External
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