Updated List of DMEPOS HCPCS Codes Potentially Subject to Pre-authorization

Members & Publications


March 30, 2018

Through an announcement in today’s Federal Register the Centers for Medicare and Medicaid Services (CMS) has updated their Master List of Items Frequently Subject to Unnecessary Utilization that could be potentially  subject to Prior Authorization as a condition of payment. No new HCPCS codes were added to the list. Effective today, the following HCPCS codes were deleted from the list:
  • E0260 - Hospital bed semi-electric (head and foot adjustment) with any type side rails with mattress.
  • E0601 -  Continuous Airway Pressure (CPAP) Device.
  • E1390 - Oxygen Concentrator.
  • K0004 -  High strength, lightweight wheelchair.

View the Final Master List of DMEPOS Items Subject To Frequent Unnecessary Utilization For Prior Authorization

Please note that the Master List contains items that are potentially subject to pre-authorization.  As of July 17, 2017, only two items were actually subject to required prior authorization:

  • K0856: Power wheelchair, group 3 std., single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
  • K0861: Power wheelchair, group 3 std., multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds

Although reference is made to a “Required Prior Authorization List,” no list by that name was identifiable on the CMS website, however CMS does note that they will publish the Required Prior Authorization List in the Federal Register with at least 60 days’ notice before implementation of prior authorization for those items on the list.

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.