K0891 prior authorization | Premera Blue Cross of Washington

K0891, Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 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: K0891
Description: Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 757 Original policy

Premera Blue Cross of Washington prior authorization

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