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Medicare Announces Nationwide Prior Authorization Requirement for Power Wheelchairs Effective Sept 1, 2018

Members & Publications

June 5, 2018

On June 5 the Centers for Medicare and Medicaid Services (CMS) announced that effective September 1, 2018 it will require prior authorization of 31 DMEPOS items; specifically a list of 31 power wheelchairs. 

Power wheelchairs have been subject to prior authorization in 19 states under a demonstration project. With this announcement, CMS is now expanding this program nationwide. With implementation of this program, prior authorization will be a condition of payment. CMS indicates that the prior authorization request must include evidence that the item complies with all applicable Medicare coverage, coding and payment rules. 

For the full program announcement, including the list of DMEPOS codes subject to prior authorization, visit the Government Publishing Office website.  Your Academy will continue to monitor this issue and share educational resources on prior authorization once CMS releases them.  

Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.

 

 

 

 

 

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