E0197 Air pressure pad for mattresAir pressure pad for mattress, standard mattress length and width
2 of 2 payer prior-auth lists that name E0197 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, Rocky Mountain Health Plans.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross and Blue Shield of Texas | Texas PA exemption (gold card), outpatient, fully insured | TX | prior auth required | Gold-card exemption available | Jul 1, 2026 | BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) |
| Rocky Mountain Health Plans | Rocky Mountain Medicare Advantage D-SNP | CO | prior auth required | Feb 1, 2025 | Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025 |
E0197 appears in 5 coverage policies from Aetna, Anthem, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Hospital Beds and Accessories (0543) | listed, no stance | Sep 23, 2026 | payer document |
| Aetna | Pressure Reducing Support Surfaces (0430) | covered if criteria are met | Jul 10, 2026 | payer document |
| Anthem | Pressure-Reducing Support Surfaces (CG-DME-16) | covered if criteria are met | Aug 13, 2026 | payer document |
| Capital Blue Cross | Hospital Beds and Accessories (MP 6.001) Procedure codes | covered if criteria are met | Mar 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Hospital Beds and Related Equipment (DME101.001) HCPCS Codes A4640, E0181, E0182, E0183, E0184, E0185, E0186, E0187, E0188, E0189, | listed, no stance | Jan 1, 2026 | payer document |
Prior authorization required or conditional in CO, IN, LA, MA, MS, ND, NY, VA, WA, WV.
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.