DME Prior Authorization Updates
CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (collectively, “CareFirst”) is continually working with healthcare delivery partners to optimize Utilization Management (UM) strategies to increase efficiencies and control costs while ensuring members receive affordable, quality care. Prior Authorization helps balance access with appropriate utilization of high-cost durable medical equipment.
We recently shared updates made to the Prosthetics Medical Policy (1.04.001A – Prosthetics), specifically around prior authorization requirements. Effective June 1, 2023, the following DME procedure codes will require prior approval for BlueChoice HMO members:
- L2006 – Knee ankle foot device, any material, single or double upright, swing and stance phase microprocessor control with adjustability, includes all components (e.g., sensors, batteries, charger), any type activation, with or without ankle joint(s), custom fabricated.
- L8701 – Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated.
- L8702 – Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated.
Our Durable Medical Equipment List has been updated with this information. For more information on prior authorizations, access our Pre-Cert/Pre-Auth page on provider.carefirst.com. For step-by-step guidance on how to enter authorizations, please access our on-demand training available on the Learning and Engagement Center.