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January 13, 2026

Exemption Process for Prior Authorization of Certain DMEPOS Items

Certain DMEPOS suppliers will be offered exemption from prior authorization per CMS.

How it will work:

  • DME Medicare Administrative Contractors (MACs) will review approval ratings of suppliers' prior authorization claims.
  • If the supplier's approval rate is 90% or higher, they will have an option each year to be exempt from submitting prior authorizations for that year.
  • To determine supplier eligibility for continued exemption, the DME MACs will conduct an annual post payment medical review sample to ensure compliance.
    • From this claim sample, suppliers must again meet a claim approval rate of 90% or greater to continue their exemption.
  • Suppliers who do not meet the 90% compliance rate threshold must continue submitting prior authorization requests as a condition of payment.
  • The DME MAC will notify suppliers at least 60 days before an exemption starts or is withdrawn before the effective date.

Stay tuned for more details!

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