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.