New DME authorization requirement for Q0508, effective July 15

Effective July 15, 2025, we’ll require prior authorization for HCPCS code Q0508 – used for miscellaneous supplies or accessories used with an implanted ventricular assist device (VAD) –when exceeding our standard DME thresholds:

• Over $1,000 for commercial and Medicare plans
• Over $500 for Medicaid plans

Prior authorization will be submitted in GuidingCare, accessed through prism’s authorizations request tool (login required).