Medicare’s New DMEPOS Prior Authorization Requirement

DMEPOS Prior Authorization
December 31, 2015
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As of the beginning of 2016, CMS is starting a prior authorization process for certain DMEPOS. If you have not already heard of this new authorization requirement, you are likely to hear quite a bit about it in the next month or two.

The good news is that the number of items subject to prior authorization is limited and most physician groups do not supply these items.  For example, this list does not include the typical custom orthotics provided by hand therapists, so these orthotics will not be subject to prior authorization.

CMS has released a master list of items that might be subject to prior authorization which is Table 5 in the following link.  https://www.federalregister.gov/articles/2015/12/30/2015-32506/medicare-program-prior-authorization-process-for-certain-durable-medical-equipment-prosthetics#t-5.  

CMS will not require that all of these items be pre-authorized.  Instead, CMS will issue a notice in the near future that includes which of these items will actually be subject to prior authorization. Once CMS issues this notice, suppliers will have 60 days before the prior authorization process applies.

The following link is to the CMS announcement regarding this new requirement.

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-12-29.html