`E1594` Cycler dialysis machine

Cycler dialysis machine for peritoneal dialysis

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: CMS Policy

Payer policies and prior authorization for E1594

1 of 1 payer prior-auth lists that name E1594 require prior authorization or set conditions: Humana.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Humana	Humana Healthy Horizons	OK	prior auth required		Jan 1, 2027	Humana Healthy Horizons® in Oklahoma Prior Authorization Notification List (PAL) The following preauthorization and notification list

Payer coverage policies that name E1594

E1594 appears in 2 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Dialysis (0541)	covered if criteria are met	Aug 26, 2026	payer document
Blue Cross & Blue Shield of Mississippi	Continuous Arteriovenous Hemofiltration (L.8.02.400)	covered if criteria are met		payer document

Recent prior-auth changes

Mar 1, 2025: PA removed, Rocky Mountain Health Plans
Mar 1, 2025: PA removed, Rocky Mountain Health Plans

Medicaid fee-for-service

Prior authorization required or conditional in LA, OH.

CO: $662.94 (health_first_colorado), effective Jul 1, 2026
IN: $0.00 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 6, 2018
LA: $344.71 (dme), effective Sep 1, 2021
TX: $5719.46 (dmepos_tos_9_e_j_l_and_r, Home Health Dme), effective Sep 1, 2026
VT: $0.00 (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.

E1594 Cycler dialysis machine