Safety Items (CPB 0623, reviewed 2026-09-23)

IMMEDIATELY: Billing team must implement the following controls to prevent claim denials: (1) Before submitting ANY claim for safety items (CPT 61304-61619, HCPCS A4467, A8000-A8004, A9279), verify the member's plan type in the Aetna system — standard plans automatically exclude all safety items regardless of medical necessity, so claims will be DENIED; (2) For non-standard plans only, require providers to submit a completed Standard Written Order (SWO) containing: member name/ID, order date, item description (HCPCS code and quantity), treating practitioner name and NPI, and signature BEFORE processing any claim; (3) Verify in the medical record that documentation supports medical necessity (NOT supplier statements or attestations alone) demonstrating the member has a condition placing them at increased injury risk; (4) For helmets (A8000-A8003), confirm medical necessity only for post-cranial surgery, seizures, balance disorders, or head-banging behaviors; (5) For safety restraints/vests (A4467), confirm neurocognitive or physical disability increasing injury risk; (6) Educate providers that telephone alert systems, fire extinguishers, first aid kits, hearing protectors, and service animals are NOT covered; (7) Update billing software rules to flag safety item codes for manual review and SWO verification before submission. Claims submitted without completed SWO or without sufficient medical record documentation will be denied as not medically necessary.