E0941 Gravity assisted traction de

Gravity assisted traction device, any type

Medically Unlikely Edits (effective October 1, 2026)

Medicare pricing for E0941

DMEPOS fee schedule, July 2026 (DME26-C)

Payer policies and prior authorization for E0941

Payer coverage policies that name E0941

E0941 appears in 11 coverage policies from Premera Blue Cross, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
Premera Blue CrossNon-covered Services and Procedures
Page | 14 of 30 | ∞		listed, no stanceJun 1, 2026payer document
UnitedHealthcareHome Traction Therapy (CS058.Q)listed, no stanceMay 1, 2026payer document
UnitedHealthcareHome Traction Therapy (2026T0545Y)listed, no stanceApr 1, 2026payer document
UnitedHealthcareHome Traction Therapy (for Idaho Only) (CS058ID.C)listed, no stanceJul 1, 2026payer document
UnitedHealthcareHome Traction Therapy (for Kansas Only) (CS058KS.02)listed, no stanceMay 1, 2026payer document
UnitedHealthcareHome Traction Therapy (for Kentucky Only) (CS058KY.09)listed, no stanceMay 1, 2026payer document
UnitedHealthcareHome Traction Therapy (for Nebraska Only) (CS058NE.Q)listed, no stanceMay 1, 2026payer document
UnitedHealthcareHome Traction Therapy (for New Jersey Only) (CS058NJ.Q)listed, no stanceMay 1, 2026payer document
UnitedHealthcareHome Traction Therapy (for Ohio Only) (CS058OH.E)listed, no stanceJun 1, 2026payer document
UnitedHealthcareHome Traction Therapy (for Pennsylvania Only) (CS058PA.Q)listed, no stanceAug 1, 2026payer document
UnitedHealthcareHome Traction Therapy (for Tennessee Only) (CS058TN.Q)listed, no stanceMay 1, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in CO, KY, LA, MA, MS, OH, VA, WA.

  • AZ: $446.62 (dme), effective Oct 1, 2026
  • CO: $478.45 (chp_plus, non-facility), effective Jul 1, 2026
  • IN: $505.83 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2025
  • KY: $618.50 (dme), effective Jan 1, 2026
  • LA: $253.46 (dme), effective Sep 1, 2021
  • MD: $525.73 (dme), effective Apr 1, 2026
  • MS: $42.06 (comprehensive), effective Jul 1, 2026
  • NE: $1.60 (dme), effective Jul 1, 2026
  • OH: $451.46 (dme), effective Jul 26, 2007
  • OK: $61.85 (dme), effective Jan 1, 2026
  • TX: $41.93 (dmepos_tos_9_e_j_l_and_r, Home Health Dme), effective Apr 1, 2013
  • VA: $584.51 (dme), effective Dec 1, 2026
  • VT: $462.74 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $52.57 (medical_equipment_supplies), effective Jul 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.