Reminder: Prior Authorization Changes for Certain DME

Reminder: Prior Authorization Changes for Certain DME

In October 2019, BlueCross BlueShield of South Carolina announced that prior authorization would no longer be required for the following durable medical equipment (DME) codes.

•    E0601 — Continuous Positive Airway Pressure (CPAP)
•    E0561 — Humidifier, Non-Heated, Used with Positive Airway Pressure
•    E0562 — Humidifier, Heated Used with positive Airway Pressure
•    G0378 — Hospital Observation Service, Per Hour

The following lines of business are included in this change:

•    National Alliance (except for Publix and Galliano Marine)
•    BlueChoice and Exchange plans when performed in-network
•    Administrative Service Only Groups
•    Major Group
•    Small Group & Individual
•    Federal Employee Plans
•    State Health Plans

Please update your office staff and practice management systems to reflect this change.

If you have any questions regarding this bulletin, please contact Provider Education directly at or reach out to your dedicated Provider Relations Consultant.