Prior Authorization Rules Updated for DMEPOS
- By Brad Ericson
- In Coding
- July 6, 2017
- Comments Off on Prior Authorization Rules Updated for DMEPOS
The Centers for Medicare and Medicaid Services (CMS) have released an update to the prior authorization process for certain durable medical equipment, prosthetic, orthotics, and supplies (DMEPOS) items.
As originally announced in the Federal Register, published on December 21, 2016, CMS is preparing for the nationwide expansion of the prior authorization process for the first two items of durable medical equipment to be subject to required prior authorization beginning on July 17, 2017:
- K0856: Power wheelchair, group 3 std., single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
- K0861: Power wheelchair, group 3 std., multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
Suppliers or beneficiaries submitting the first claims in the series for these items must receive prior authorization before the item is furnished or a claim is submitted, as a condition for payment. Durable medical equipment Medicare administrative contractors (DME MACs) began accepting prior authorization requests for this expansion July 3, 2017.
Director of Publishing at AAPC
Brad Ericson, MPC, CPC, COSC, is a seasoned healthcare writer and editor.He directed publishing at AAPC for nearly 12 years and worked at Ingenix for 13 years and Aetna Health Plans prior to that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.
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