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CMS Announces Prior Authorization Program for Certain DMEPOS

Dec 22, 2016

Centers for Medicare & Medicaid Services (CMS) announced the implementation of the prior authorization program for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items in two phases and the issuance of the initial Required Prior Authorization List of DMEPOS items that require prior authorization as a condition of payment. The initial items requiring pre-authorization only consist if the two following HCPCS codes:

  • 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

Implementation of this new preauthorization requirement will be accomplished in 2 phases. Phase one of the implementation is effective on March 20, 2017. Only four states will be required to use the preauthorization process at that time, one from each DME region. They are:

  • New York –Jurisdiction A
  • Illinois –Jurisdiction B
  • West Virginia –Jurisdiction C
  • Missouri –Jurisdiction D

Phase two of the implementation is effective on July 17, 2017, at which point the preauthorization requirements will be extended nationally. The full notice can be found here and in the Federal Register.