Certain DMEPOS Suppliers Subject to Prior Authorization Change Starting in October

Starting Oct. 15, 2026, the Centers for Medicare & Medicaid Services (CMS) will require probationary prior authorization for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items billed by newly enrolled suppliers and suppliers undergoing changes of ownership.

Probationary Period

The Probationary Prior Authorization Process is authorized under Section 1866(j)(3) of the Social Security Act and 42 CFR §424.527, which establishes a one-year probationary period for newly enrolled suppliers and DMEPOS suppliers changing ownership on or after Oct. 15. All such suppliers must submit a prior authorization request before delivering any of the DMEPOS items listed on the DMEPOS Probationary Prior Authorization List.

The Probationary Prior Authorization Process will follow the same submission and review steps as the established Prior Authorization Process for Certain DMEPOS Items. It does NOT replace this process. Suppliers participating in the Probationary Prior Authorization Process must continue to comply with the existing prior authorization requirements for applicable DMEPOS items.

You can find the full list of codes requiring prior authorization here on the CMS website (updated July 29, 2026).

Why the Change?

Prior authorization allows suppliers to ensure that a DMEPOS item meets applicable Medicare coverage, payment, and coding rules before items are delivered. This new probationary period aims to better ensure proper payments for and timely delivery of DMEPOS supplies.