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The following sections of the Fidelis Care authorization grids have been updated effective February 1, 2025.
The following codes have been added to the Medicaid DME Authorization Grid:
E0316
Safety enclosure frame/canopy for use with hospital bed, any type
E1803
Dynamic adjustable elbow extension only device, includes soft interface material
E1804
Dynamic adjustable elbow flexion only device, includes soft interface material
E1807
Dynamic adjustable wrist extension only device, includes soft interface material
E1808
Dynamic adjustable wrist flexion only device, includes soft interface material
E1813
Dynamic adjustable knee extension only device, includes soft interface material
E1814
Dynamic adjustable knee flexion only device, includes soft interface material
E1822
Dynamic adjustable ankle extension only device, includes soft interface material
E1823
Dynamic adjustable ankle flexion only device, includes soft interface material
E1826
Dynamic adjustable finger extension only device, includes soft interface material
E1827
Dynamic adjustable finger flexion only device, includes soft interface material
E1828
Dynamic adjustable toe extension only device, includes soft interface material
E1829
Dynamic adjustable toe flexion only device, includes soft interface material
Visit: Authorization Grids
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