Fidelis Care Authorization Grids Effective February 1, 2025
12/30/2024
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Posted by Provider Relations
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