Medical Equipment & Supplies – Compression garments and bathroom equipment

Washington State Health Care Authority sent this bulletin at 03/20/2025 01:21 PM PDT

March 20, 2025

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Apple Health (Medicaid) Provider Alert

Attention Medical Equipment and Supplies providers:

Provider Billing Guide Updates for Medical Equipment and Supplies regarding compression garments and bathroom equipment

Effective for dates of service on and after April 1, 2025, the Health Care Authority (HCA) added HCPCS procedure codes for compression garments to the Medical Equipment and Supplies Billing Guide. HCA also removed prior authorization (PA) requirements for certain bathroom equipment supplies.

Compression garments

Suppliers and providers should discontinue using miscellaneous HCPCS code A4659 to bill for compression garments when an approved, specific HCPCS code is available. Claims should be submitted using the appropriate assigned HCPCS code for the item provided. See the Medical Equipment and Supplies Billing Guide effective April 1, 2025, for code details.

Bathroom equipment

The following HCPCS codes no longer require PA:

E0243: Toilet rail, each

E0244: Raised toilet seat

E0245: Tub stool or bench

E0163: Commode chair with fixed arm

E0165: Commode chair with detacharm

E0167: Commode chair pail or pan, replacement only

E0175: Commode chair foot rest

Fee Schedule

See HCA’s Provider and billing guides and fee schedules webpage, under Medical equipment and supplies, for the updated fee schedule published January 1, 2025.

Questions?

Direct all questions related to this alert to the FFS Durable Medical Equipment (DME) Program.

For specific PA questions, contact the Authorization Services Office (ASO).

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.

Medical Equipment & Supplies – Compression garments and bathroom equipment

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination