`E0239` Hydrocollator unit portable

Hydrocollator unit, portable

Medicare coverage: Special coverage instructions apply
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: Published Contractor Policy

Medicare pricing for E0239

DMEPOS fee schedule, July 2026 (DME26-C)

NU (purchased, new), inexpensive or routinely purchased (IN): non-rural $544.91 to $641.07 in the contiguous states; $544.91 to $2,412.13 in AK, HI, PR and VI; ceiling $641.07, floor $544.91
RR (rental), inexpensive or routinely purchased (IN): non-rural $54.50 to $64.12 in the contiguous states; $54.50 to $241.18 in AK, HI, PR and VI; ceiling $64.12, floor $54.50
UE (purchased, used), inexpensive or routinely purchased (IN): non-rural $408.70 to $480.82 in the contiguous states; $408.70 to $1,809.05 in AK, HI, PR and VI; ceiling $480.82, floor $408.70

Payer policies and prior authorization for E0239

2 of 2 payer prior-auth lists that name E0239 require prior authorization or set conditions: Humana, Passport by Molina Healthcare (Kentucky).

Payer	Plan	State	Prior auth	Conditions	Since	Source
Humana	Humana Healthy Horizons	VA	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL)
Passport by Molina Healthcare (Kentucky)	Medicaid	KY	prior auth under conditions	State exception; PA above quantity limits	Jul 1, 2026	Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026

Payer coverage policies that name E0239

E0239 appears in 2 coverage policies from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Back Pain - Invasive Procedures (0016)	listed, no stance (range E0200-E0239)	Oct 6, 2026	payer document
Aetna	Heating Devices (0540)	not covered	Jul 31, 2026	payer document

Recent prior-auth changes

Jan 1, 2027: PA added, Humana
Jul 1, 2026: PA removed, Humana

Medicaid fee-for-service

Prior authorization required or conditional in KY, VA.

AZ: $668.87 (dme), effective Oct 1, 2026
IN: $454.10 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KY: $380.71 (dme), effective Jan 1, 2026
NE: $47.68 (dme), effective Jul 1, 2026
OK: $64.12 (dme), effective Jan 1, 2026
VA: $576.96 (dme), effective Dec 1, 2026
VT: $537.37 (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.

E0239 Hydrocollator unit portable