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- The DME MAC will notify suppliers at least 60 days before an exemption starts or is withdrawn before the effective date.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!

