Date: 04/15/2022
As part of our annual review of durable medical equipment’s preauthorization requirements in collaboration with our partner, eviCore, we have determined that the following 18 CPT Codes will be added to the EmblemHealth Preauthorization List starting Aug. 1, 2022.
New Codes Requiring Preauthorization Starting Aug. 1, 2022 |
|
|---|---|
| CPT Code | CPT Code Description |
| A4230 | Infusion set for external insulin pump, non-needle cannula type |
| A4232 | Syringe with needle for external insulin pump, sterile, 3 cc |
| A4238 | Supply allowance for adjunctive continuous glucose monitor (CGM), includes all supplies and accessories |
| A4351 | Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
| A4352 | Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each |
| A4353 | Intermittent urinary catheter, with insertion supplies |
| A4409 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
| A4520 | Incontinence garment, any type, (e.g., brief, diaper), each |
| A4554 | Disposable underpads, all sizes |
| A6197 | Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
| A9274 | External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
| A9275 | Home glucose disposable monitor, includes test strips |
| E0570 | Nebulizer, with compressor |
| E0607 | Home blood glucose monitor |
| K0553 | Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1-month supply = 1 unit of service |
| K0554 | Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
| E2102 | Adjunctive continuous glucose monitor or receiver |
| K1030 | External recharging system for battery (internal) for use with implanted cardiac contractibility modulation generator, replacement only |
In addition, the following three CPT Codes will be removed from the preauthorization list:
Codes Being Removed From Preauthorization List Starting Aug. 1, 2022 |
|
|---|---|
| CPT Code | CPT Code Description |
| A9276 | Sensor; invasive (e.g., subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, one unit = 1 day supply |
| A9277 | Transmitter; external, for use with interstitial continuous glucose monitoring system |
| A9278 | Receiver (monitor); external, for use with interstitial continuous glucose monitoring system |
