May 9, 2024
Prior Authorization for Replacement of Power Mobility Devices (PMDs) – Effective June 02, 2024
Starting June 02, 2024, CGS will require prior authorization on all replacement PMDs on the Required Prior Authorization List
. This includes lost, stolen, or irreparably damaged items. CGS will deny claims for replacement PMDs with the RA modifier that did not receive prior authorization.
Replacement Due to Loss, Theft, or Irreparable Damage
Include this documentation with your request:
- Information and detailed reports that explain the reasons leading to the need for replacement:
- Loss or theft (for example a police report), or
- Irreparable damage due to a specific accident or to a natural disaster such as a fire or flood.
- A physician’s Written Order Prior to Delivery (WOPD). The DME MACs require a new order for replacement items.
- If the original prior authorization was affirmed, the DME MACs will not review for medical necessity.
- Select “Expedited Request” and give the reason for replacement.
Replacements Due to Change in Medical Need or Reasonable Useful Lifetime Met
Include this documentation with your request:
- A new face-to-face evaluation
- WOPD
- Documentation from the medical record that supports the need for the item ordered and documentation to support the change in condition if applicable.
How to Submit a Prior Authorization Request
- DME myCGS portal – the fastest, easiest way to send prior authorization requests and check the status.
- Mail, fax, and esMD – use the Prior Authorization (PA) Submission Form
.
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