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Required Prior Authorization Programs

Updated: 08.17.18

CMS has selected 31 items of durable medical equipment to be subject to required prior authorization nationwide on September 1, 2018. The Healthcare Common Procedure Coding System (HCPCS) codes added to the Required Prior Authorization List are were included in the Prior Authorization of Power Mobility Devices (PMDs) Demonstration, which ends August 31, 2018. The Federal Register Notice is available hereExternal Website.

All new claims for these PMDs with a date of delivery on or after September 1, 2018 must be associated with a prior authorization request as a condition of payment. Therefore, lack of a provisionally affirmed prior authorization request will result in a claim denial.

Required Prior Authorization Listing

Resources

CMS Resources

Updated: 08.17.18

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