All PlansPrior AuthMedium impact
Prior authorization via web-based tool for durable medical equipment
Blue Cross Blue Shield of Rhode Island·RI · PM&R (Physical Medicine & Rehab), Orthopedics, Family Medicine +1 more·Physician / Facility
Effective date
Jan 1, 2021
We identified it
Jun 19, 2026
Summary
Effective January 1, 2021, several HCPCS codes for durable medical equipment no longer require prior authorization. Eight codes (E0265, E0266, E0296, E0297, E0481, E0936, E0983, E0984) are no longer covered per CMS guidance, while five codes (E0484, E1800, E1802, E1805, E1825) remain covered services without prior auth requirements.
Action Required
Immediately: Billing team must update system to remove prior authorization requirements for HCPCS codes E0484, E1800, E1802, E1805, and E1825. Stop billing codes E0265, E0266, E0296, E0297, E0481, E0936, E0983, and E0984 as they are no longer covered services. Update encounter forms and billing software to reflect these changes.