Article Detail - JA DME

Effective for date of service (DOS) on or after January 1, 2024, a temporary gap period is in place for the Competitive Bidding Program (CBP). The competitive bid modifiers KV, J4, and J5 are no longer valid. Treating practitioners and previously non-contract suppliers under competitive bid requirements, now have the flexibility for HCPCS codes L0648, L0650, L1833, and L1851. They can choose to follow the standard prior authorization process with its typical review timeframe, request an expedited review, or use the ST modifier to indicate an acute/emergent need.

It is crucial to note that this procedural change specifically impacts non-contract competitive bid suppliers who are practitioners/physicians, physical therapists, and occupational therapists. For more detailed information, please refer to the Timeline and Updates section of the Prior Authorization and Pre-Claim Review Initiatives webpage on the CMS website.