Prior Authorization for Certain DMEPOS

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