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July 29, 2024

Effective August 12, 2024: New Codes Added to Required Prior Authorization

DMEPOS Suppliers need to be aware of the following changes that will start on August 12, 2024:

  • Orthoses:
    • Effective August 12, 2024, Medicare will not require prior authorization and face-to-face encounter and Written Order Prior to Delivery (WOPD) for HCPCS code L1833.
    • CMS selected six more orthoses codes for required prior authorization to begin nationwide on August 12, 2024: L0631, L0637, L0639, L1843, L1845, L1951.
    • We will begin accepting prior authorization requests for the added codes on July 29, 2024.
    • CMS selected eight more orthoses codes for required face-to-face encounter and written order prior to delivery (WOPD): L0635, L0636, L0638, L0639, L0640, L0651, L1845, and L1852
  • Osteogenesis Stimulators:
    • CMS selected three HCPCS codes (E0747, E0748, E0760) subject to required prior authorization.
    • There will be two phases of implementation:
      • Phase one begins August 12, 2024, in California, Florida, Ohio, and Pennsylvania.
      • We will begin accepting phase one requests on July 29, 2024.
      • Phase two begins November 12, 2024, in all remaining states and territories not included in phase 1.
      • We will begin accepting phase 2 requests October 29, 2024.

Need help knowing which codes apply?

Use the Prior Authorization Code Lookup and WOPD Code Lookup

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