MEDICARE TO REQUIRE PRIOR AUTH ON DME ITEMS

Please be aware for all Medicare DME Approved suppliers that the prior authorization list for Medicare is updating.

THIS DIRECTLY AFFECTS US THIS YEAR

Many orthosis items are now on the prior auth list, specifically common items such as:

E0748

E0746

L0631

L0637

L0648

L0650

L1005

L1832

L1834

L1845

The requirements for prior auth will be released in phases. Please locate your state to determine when you are affected.

Orthoses Requirements
CMS selected five HCPCS codes (L0648, L0650, L1832, L1833, and L1851) subject to required prior authorization. Implementation of this requirement will be completed in three phases.

Phase one begins April 13, 2022 in New York, Illinois, Florida, and California. Phase two begins July 12, 2022 in Maryland, Pennsylvania, New Jersey Michigan, Ohio, Kentucky, Texas, North Carolina, Georgia, Missouri, Arizona, and Washington.

Phase three begins October 10, 2022 in all remaining states and territories not included in phase 1 or phase 2.

You can read more here: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/DMEPOS/Prior-Authorization-Process-for-Certain-Durable-Medical-Equipment-Prosthetic-Orthotics-Supplies-Items

I also attached the entire prior auth list.

If you are part of Triple B's auth program, please remember to request prior auth PRIOR to delivering items so that we may obtain.

If you obtain your own auths, please remember to request prior auth PRIOR to delivering items and provide the auth approval number on the fee slip.

We will send out reminders close to each state release date.

Thank you