`A8002` Soft protect helmet custom

Helmet, protective, soft, custom fabricated, includes all components and accessories

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy
DME supplier: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for A8002

DMEPOS fee schedule, July 2026 (DME26-C)

NU (purchased, new), inexpensive or routinely purchased (IN): no amount on file (priced by the DME MAC)
RR (rental), inexpensive or routinely purchased (IN): no amount on file (priced by the DME MAC)
UE (purchased, used), inexpensive or routinely purchased (IN): no amount on file (priced by the DME MAC)

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for A8002

2 of 2 payer prior-auth lists that name A8002 require prior authorization or set conditions: Blue Shield of California Promise Health Plan, UnitedHealthcare Community Plan.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Shield of California Promise Health Plan	Promise Health Plan Medi-Cal	CA	prior auth required		Sep 1, 2026	Medi-Cal Prior Authorization List
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Kentucky	KY	prior auth under conditions	Cost over $500	Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026

Payer coverage policies that name A8002

A8002 appears in 3 coverage policies from Aetna, Cigna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Hospital Beds and Accessories (0543)	not covered	Sep 23, 2026	payer document
Aetna	Safety Items (0623)	not covered	Sep 23, 2026	payer document
Cigna	Orthotic Devices and Shoes (0543)	not covered	Sep 15, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in CO, IL, IN, KY, LA, MA, MD, MS, NY, OH, VA, WA, WV.

AZ: $195.42 (dme), effective Oct 1, 2026
CO: $392.48 (health_first_colorado), effective Jul 1, 2026
FL: $265.41 (dme), effective Jul 1, 2026
LA: $303.66 (dme), effective Sep 1, 2021
NY: $430.26 (dme), effective Jul 1, 2026
OH: $441.26 (dme), effective Jan 1, 2010
TX: $426.00 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Apr 1, 2017
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

A8002 Soft protect helmet custom