K0853 prior authorization | Premera Blue Cross of Washington

K0853, Power wheelchair, group 3 very heavy-duty, captain's chair, patient weight capacity 451 to 600 pounds 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: K0853
Description: Power wheelchair, group 3 very heavy-duty, captain's chair, patient weight capacity 451 to 600 pounds These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 749 Original policy

Premera Blue Cross of Washington prior authorization

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