Nationwide Expansion of the Condition of Payment Prior Authorization Program for Lower Limb Prosthetics

In December 2016, CMS issued a final rule that established a Condition of Payment Prior Authorization (COPPA) process for certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) that are frequently subject to unnecessary utilization. This process was implemented in March 2017 for two HCPCS codes and expanded to include 45 items as of July 2019.

The COPPA program expanded September 1, 2020 to include six lower limb prosthetic (LLP) HCPCS codes for beneficiaries residing in California, Michigan, Pennsylvania and Texas.

Effective December 1, 2020 prior authorization will be required for the six LLP HCPCS codes L5856, L5857, L5858, L5973, L5980, and L5987 in all U.S. states and territories. DME MACs will begin accepting LLP prior authorization requests under the COPPA program November 17, 2020 for planned dates of service on/after December 1, 2020.

See theRequired Prior Authorization Programs webpage for information on prior authorization request submission and education resources.

            Last Updated Thu, 12 Nov 2020 16:59:56 +0000