E1290 Wheelchair hvy duty detach aHeavy duty wheelchair, detachable arms (desk or full length) swing away detachable footrest
9 of 9 payer prior-auth lists that name E1290 require prior authorization or set conditions: Humana, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Humana | Humana Healthy Horizons | KY | prior auth required | Jan 1, 2027 | please visit Humana Healthy Horizons in Kentucky Clinical coverage policies. | |
| Humana | Humana Healthy Horizons | OH | prior auth required | Jan 1, 2027 | 555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification list | |
| UnitedHealthcare Community Plan | District of Columbia LTSS | DC | prior auth under conditions | Prior authorization required only for the codes listed with a retail purchase or a cumulative rental cost of less than $500. | Oct 1, 2026 | Prior Authorization Requirements for District of Columbia LTSS Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Indiana Hoosier Care Connect | IN | prior auth under conditions | Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $500. | Oct 1, 2026 | Prior authorization requirements for Indiana Hoosier Care Connect Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Indiana PathWays for Aging (MLTSS) | IN | prior auth under conditions | Prior authorization required only for DME codes listed with a retail purchase or cumulative rental cost of more than $500. | Oct 1, 2026 | Prior authorization requirements for Indiana MLTSS Pathways Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Massachusetts OneCare | MA | prior auth under conditions | Cost over $1,000 | Nov 1, 2025 | Prior authorization requirements for Massachusetts OneCare Effective November 1, 2025 |
| UnitedHealthcare Community Plan | Massachusetts Senior Care Options (SCO) | MA | prior auth under conditions | Prior authorization is required only for a retail purchase or cumulative rental cost of more than | Nov 1, 2025 | CPT® is a registered trademark of the American Medical Association. Prior authorization requirements for Massachusetts Senior Care Options Effective November 1, 2025 |
| UnitedHealthcare Community Plan | Massachusetts Senior Care Options (SCO) and OneCare | MA | prior auth under conditions | Cost over $1,000 | Oct 1, 2026 | Prior authorization requirements for Massachusetts MA SCO OneCare Effective October 1, 2026 |
| 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 |
E1290 appears in 5 coverage policies from Aetna, Anthem, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Wheelchairs and Power Operated Vehicles (Scooters) (0271) | covered if criteria are met | Aug 21, 2026 | payer document |
| Anthem | Wheeled Mobility Devices: Manual Wheelchairs - Standard, Heavy Duty and Lightweight (CG-DME-24) | covered if criteria are met (range E1280-E1295) | Nov 6, 2025 | payer document |
| Capital Blue Cross | Manual Wheelchairs and Accessories (MP 6.059) | covered if criteria are met | Sep 1, 2026 | 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 | Wheelchairs (Manual or Motorized) (1.01.501) Page | 12 of 26 | ∞ | listed, no stance | May 11, 2026 | payer document |
Prior authorization required or conditional in CO, IN, KY, LA, MS, VA, VT.
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.