DME Services Requiring Authorization - CPT E1399

Harvard Pilgrim requires Prior Authorization for:

• Continuous Glucose Monitoring Systems
• Miscellaneous DME (i.e., HCPCS code E1399)
• Sleep therapy equipment including CPAP, APAP, BIPAP, and equipment required for PAP re-supply for members 18 years of age and older.1 (See Sleep Studies/Sleep Therapy Authorization policy for additional information.)
• DME obtained from or requested by non-contracted vendors or providers (not applicable for POS or PPO members)

Harvard Pilgrim’s Medical Review Criteria (used to review Prior Authorization requests) is available online in the Medical Management section of Harvard Pilgrim’s provider site at www.harvardpilgrim.org. A copy of current Medical Review Criteria may also be obtained by contacting Harvard Pilgrim’s Provider Service Center at 800-708-4414.


Action Required
When possible, requests for prior authorization for DME should be submitted at least one week prior to the date of service to allow sufficient time to evaluate member eligibility, level of benefits and medical necessity. Authorization may be requested using HPHConnect, NEHEN or by contacting the Referral and Authorization Unit at 800-708-4414.

To obtain DME, the ordering clinician should call the Harvard Pilgrim contracted vendor directly. (Refer to Harvard Pilgrim’s Provider Directory for a list of approved DME vendors.)


The DME vendor is responsible for obtaining authorization when required. (In urgent situations, contracted vendors may initiate services ordered outside normal business hours without obtaining prior authorization; the vendor is responsible for contacting HPHC on the next business day to request retrospective authorization.)