CMS issued a final rule that established a prior authorization (PA) process as a condition of payment for certain DMEPOS items that are frequently subject to unnecessary utilization.

The Master List contains the DMEPOS items identified as being frequently subject to unnecessary utilization; however, presence on this list does not automatically create a PA requirement for that item. CMS will implement a subset of items from the Master List (referred to as the "Required Prior Authorization List") and publish in the Federal Register with at least 60 days' notice before PA implementation of those items.

Access the below related information from this page.

• Pre-Claim Hotline
• Prior Authorization for Lower Limb Prosthetics
• Prior Authorization for Orthoses
• Prior Authorization for Power Mobility Devices
• Prior Authorization for Pressure Reducing Support Surfaces

Prior Authorization Timelines

Resources

• CMS Medicare Learning Network (MLN) Matters Special Edition (SE)18010 - Inclusion of Power Mobility Device Codes in the Prior Authorization Program for DMEPOS Items
• Federal Register Final Rule: Medicare Program; Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies