8/1/2025
•
Posted by Provider Relations
The following section of the Fidelis Care authorization grids have been updated effective September 1, 2025.
The following code has been updated on the Medicare Authorization Grid and requires prior authorization:
Durable Medical Equipment/Supplies:
E1012 Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each
The following section of the Fidelis Care authorization grids have been updated effective July 1, 2025.
The following codes have been updated on the Medicare Authorization Grid and no longer require prior authorization:
|
Service Category
|
Services
|
Procedure Codes
|
|
Durable Medical Equipment
|
Orthotic & Prosthetic
|
A5500, L2820, L3908, L5685
|
|
Nutritional Services
|
B4034
|
|
Respiratory Devices
|
E0443, E1392, K0738
|
|
Neurostimulators
|
E0730
|
|
Supplies & Devices
|
E0849
|
|
Equipment & Accessories
|
E0951
|
|
Wheelchairs
|
E0955, E0956, E0961, E0971, E0973, E0990, E2210, E2365, E2601, E2607, E2624, K0001, K0019, K0040, K0195
|
|
Genetic Analysis
|
Genetic Testing
|
81257
|
|
Medical Supplies
|
Supplies
|
A4557, A4604
|
|
Wound Care
|
A6530
|
|
Other Medical Services
|
Other Services
|
G0249
|
|
Physician Services
|
Injections
|
20550, 20551
|
|
Infusion Services
|
96523
|
|
Office Visits
|
99243
|
|
Sleep Medicine
|
Sleep Studies
|
95806
|
If you have any questions, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.