E1087 prior authorization | Premera Blue Cross of Washington

E1087, High strength lightweight wheelchair, fixed full-length arms, swing-away detachable elevating legrests These criteria do not imply or guarantee approval., is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: E1087
Description: High strength lightweight wheelchair, fixed full-length arms, swing-away detachable elevating legrests These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 664 Original policy

Premera Blue Cross of Washington prior authorization

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