Custom Wheelchair Authorizations: Wheelchair Evaluation Required

Wednesday, May 26, 2021

Health Net Federal Services, LLC (HNFS) has revised its online authorization submission tools to better support requests for custom wheelchairs. Previously, we offered two custom wheelchair request types providers could enter when using our online submission tools – P19 and P20. Our system then would pre-populate specific Healthcare Common Procedure Coding System (HCPCS) codes for the wheelchair. However, these request types did not allow for an evaluation, which is a required step in order to complete a wheelchair assessment. 

Moving forward, providers should use request type P108 (DME Purchase and Med Supplies Generic, Outpatient) for custom wheelchair evaluation authorization requests. HNFS can then authorize two units of wheelchair management (CPT® code 97542) in order for providers to complete the wheelchair evaluation. After the evaluation, send a separate request for the custom wheelchair (also request type P108) that includes the evaluation results and pricing/supporting documentation for specific HCPCS being requested for the customized wheelchair. Please enter the P108 request type for each custom line item you are requesting. 

As specified in our approval letters, if your patient needs additional services that require prior authorization, please submit a separate, new request. Your cooperation with this guideline helps ensure timely access to care. 

Visit our Is Approval Needed? page to learn more about prior authorization requirements.