`E2403` Ext oculr neg pres pump

External ocular negative pressure pump, electric

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Payer policies and prior authorization for E2403

2 of 2 payer prior-auth lists that name E2403 require prior authorization or set conditions: Cigna.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Cigna	ACA/IFP	All	prior auth required	May be delegated to eviCore for some clients	Oct 1, 2026	Master Precertification List (For Health Care Providers)
Cigna	Complete/PHS+/Preferred	All	prior auth required	May be delegated to eviCore for some clients	Oct 1, 2026	Master Precertification List (For Health Care Providers)

Payer coverage policies that name E2403

E2403 appears in 1 coverage policy from Anthem.

Payer	Policy	Role in policy	Reviewed	Document
Anthem	Ocular Pressure Adjusting Pump Systems (DME.00055)	covered if criteria are met	Aug 13, 2026	payer document

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.

E2403 Ext oculr neg pres pump

Payer policies and prior authorization for E2403

Payer coverage policies that name E2403

`E2403` Ext oculr neg pres pump