Prior Authorization for Osteogenesis Stimulators - JA DME

The CMS final rule 42 CFR §§405 and 414., in 2016, established a Prior Authorization (PA) process for certain DMEPOS that are frequently subject to unnecessary utilization.

Effective August 28, 2024, CMS is suspending prior authorization requirements for HCPCS codes E0747, E0748, and E0760 due to continued confusion over some noninvasive osteogenesis stimulators and whether they comply with the DME three-year expected life requirement at 42 CFR 414.202. CMS plans to provide additional direction regarding the three-year expected life requirement at 42 CFR 414.202 in future notice and comment rulemaking.

More information can be found on the CMS Durable Medical Equipment (DME) Center webpage.

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Resources

• CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual
• CMS Medicare Learning Network (MLN) Fact Sheet 905364 - Complying with Medicare Signature Requirements
• DMEPOS Operational Guide
• Prior Authorization Process for DMEPOS Items Frequently Asked Questions