Coverage

• Osteogenesis Stimulator Local Coverage Determination (LCD)
• Osteogenesis Stimulator Policy Article

Documentation

• Standard Documentation Requirements for All Claims Submitted to DME MACs

Probationary Prior Authorization (PPA) program

The Probationary Prior Authorization (PPA) program provides an additional layer of oversight for newly enrolled DMEPOS suppliers and suppliers that have completed a change of ownership. Under this nationwide program, selected items require prior authorization during a one-year provisional period. Beginning October 15, 2026, two osteogenesis stimulator HCPCS codes will be added.

Probationary Prior Authorization (PPA) HCPCS codes

Prior Authorization Timelines

Documentation to Include in PA Package Submission

• Osteogenesis PA request coversheet
• Face-to-Face Evaluation (F2F)
• Written Order Prior to Delivery (WOPD)
  • Must be completed within six (6) months after the required face-to-face encounter
• Any additional medical records providing support for medical necessity
• Documentation must be submitted to the appropriate jurisdiction based on the beneficiary's permanent address with the PA coversheet for fax, mail, or electronic submission of medical documentation (esMD). For Noridian Medicare Portal (NMP) submissions, complete all required fields in the portal as a coversheet is not required.

To ensure process efficiency, assure all components are completed and included within the submission.

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