E1016 Shock absorber for power w/cShock absorber for power wheelchair, each
6 of 6 payer prior-auth lists that name E1016 require prior authorization or set conditions: Blue Shield of California Promise Health Plan, Humana, Neighborhood Health Partnership, Rocky Mountain Health Plans, UnitedHealthcare, 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 | |
| Humana | Oak Street Health | All | prior auth required | Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management | ||
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth under conditions | Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $1,000. Advance notification required when members are referred to an out-of- netwo | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 |
| 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 | |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth required | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 | |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Kentucky | KY | prior auth required | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026 |
E1016 appears in 6 coverage policies from Aetna, Anthem, Blue Shield of California, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Therapeutic Chairs (0434) | covered if criteria are met (range E0950-E1034) | Aug 3, 2026 | payer document |
| Aetna | Therapeutic Chairs (0434) | not covered (range E0950-E1034) | Aug 3, 2026 | payer document |
| Aetna | Wheelchairs and Power Operated Vehicles (Scooters) (0271) | not covered | Aug 21, 2026 | payer document |
| Anthem | Wheeled Mobility Devices: Wheelchair Accessories (CG-DME-34) | covered if criteria are met (range E1015-E1016) | Nov 6, 2025 | payer document |
| Blue Shield of California | BSC1.02 Power Wheelchairs and Power Operated Vehicles for Permanent Use | listed, no stance | payer document | |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Wheelchairs and Accessories (DME101.010) HCPCS Codes E0950, E0951, E0952, E0953, E0954, E0955, E0956, E0957, E0958, E0959, | listed, no stance | Jan 1, 2026 | payer document |
| Premera Blue Cross | Non-covered Services and Procedures Page | 14 of 30 | ∞ | listed, no stance | Jun 1, 2026 | payer document |
Prior authorization required or conditional in CO, FL, IL, IN, LA, MA, ND, 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.