Prior Authorization for Certain DMEPOS

February 11, 2016
Rick Gawenda

On December 29, 2015, the Centers for Medicare and Medicaid Services (CMS) issued the final rule that establishes a prior authorization process for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items that are frequently subject to unnecessary utilization. This process assures that all Medicare coverage, coding, and clinical documentation requirements are met before the item is furnished to the beneficiary and before the claim is submitted for payment.

CMS has released a frequently asked question document concerning the prior authorization for certain DMEPOS as well as a master list of DMEPOS items subject to frequent unnecessary utilization for prior authorization. To access both documents, click

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  1. For biofeedback, are the probes (internal and/or external) considered part of the practice expense for 90912/90913? Or can the probes be purchased by the patient and/or billed to insurance as DME?