Effective June 1, 2022: Push-Rim Activated Power Assist Wheelchair (PAPAW) System

Date: 06/01/22

Superior HealthPlan will require prior authorization for dates of service on or after June 1, 2022 for Push-Rim Activated Power Assist Wheelchair (PAPAW) system, procedure code E0986, for Medicaid STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP STAR+PLUS Medicare Medicaid Plan (MMP) members. Superior will utilize Texas Medicaid Provider Procedures Manual as the medical necessity review criteria. Superior ensures medical necessity review criteria is current and appropriate for members and the scope of services provided as a result.

Prior Authorization	Applicable Products	Criteria
Push-Rim Activated Power Assist Wheelchair (PAPAW) System (E0986)	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, MMP	Texas Medicaid Provider Procedures Manual

To review prior authorization requirements, please visit Superior’s Prior Authorization webpage.

For questions or additional information, contact Superior HealthPlan Prior Authorization department at 1-800-218-7508.