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Understanding the Supplier Prior Authorization Exemption Process for DMEPOS Providers

The Supplier Exemption Process allows certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers to be exempt from Prior Authorization (PA) requirements under specific conditions.


What Is the Exemption Process?

CMS may grant an exemption from submitting Prior Authorization Requests (PARs) to DMEPOS suppliers that demonstrate consistent compliance with Medicare coverage, coding, and payment rules.
The DME MACs will review suppliers annually to confirm continued exemption.


Eligibility Criteria

To qualify for exemption, suppliers must:

  • Submit at least 10 PARs during the annual assessment period.
  • Achieve a provisional affirmation rate of 90% or higher on initial PARs.

Important Things to Know

  • Exemption applies by jurisdiction and PTAN.
  • Claim denials follow normal appeals, but appeals don’t change exemption status.

When Will This Start?

  • The process for determining supplier exemption status began in January 2026.
  • The DME MAC will send written notifications informing suppliers of their exemption status no later than April 2, 2026

Opting Out

  • Suppliers can choose to opt out of exemption by submitting a request to the DME MAC by April 30, 2026.
      • The DME MAC will reject any requests received after April 30, 2026.
    • Suppliers must submit opt-out requests on the form. They can send the form by:
      • Fax
      • Email
      • myCGS

June 1, 2026

  • Exempt suppliers do not send PARs.
    • PARs from exempt suppliers will be rejected.
  • Suppliers who are not exempt or that have opted out must continue to submit PARs.

What Happens Next?

January 1, 2027

  • Exempt suppliers get an Additional Documentation Request (ADR) for 10 claims to check compliance.
  • Suppliers must respond to the ADR within 45 days with the requested documentation; failure to do so will result in claim denial.
  • There must be 10 paid claims by November 30 to stay exempt.
    • If there are not 10 paid claims, exemption ends.

April 2027

  • CMS sends notices:
    • Continued Exemption if you still qualify.
    • Withdrawal of Exemption if you don’t.
  • Suppliers can opt out by April 30 if you want to keep sending PARs.

June 1, 2027

  • New exemption cycle starts.
Publication History
February 19, 2026 Revised to add additional information and details.
January 20, 2026 Revised to clarify information about exemption dates and opting out.
January 13, 2026 Originally Published

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