CMS Slates Prior Authorization Call

July 11 conference call will address the prior authorization process for pressure reducing support surfaces.

CMS has scheduled a special DMEPOS Open Door Forum call to address  the addition of Pressure Reducing Support Surfaces (PRSS) to its Required Prior Authorization List, which will be held Tues., June 4, from 2 p.m. to 3:30 p.m. Eastern Time.

Participation is by conference call only. To participate, call (800) 837-1935 at least 15 minutes prior to the start time, and reference conference ID no. 5960428. TTY communications services are available for hearing-impaired participants by dialing 711 or (800) 855-2880; a relay communications assistant will help. Participants are not required to RSVP.

CMS will post a transcript and audio recording of the call to its Podcast and Transcripts website for downloading.

As reported earlier, in a Dec. 30, 2015 final rule, CMS added seven power mobility device codes and five therapeutic support surface codes. Where the support surfaces are concerned, one phase that covers California, Indiana, New Jersey, and North Carolina, will implement those codes July 22. In the second phase, CMS will implement prior authorization for those codes nationally on Oct. 21.

CMS has added the following five Healthcare Common Procedure Coding System (HCPCS) codes to the list of DMEPOS items that require prior authorization as a condition of payment:

  • E0193 Powered air flotation bed (low air loss therapy)
  • E0277 Powered pressure reducing air mattress
  • E0371 Nonpowered advance pressure reducing overlay for mattress length and width
  • E0372 Powered air overlay for mattress, standard mattress length and width
  • E0373 Nonpowered advanced pressure reducing mattress

(Further details are in Federal Register Notice 84 FR 16616, which was published on April 22.)

The Special Open Door Forum will discuss how to submit a prior authorization request to the designated MAC; the timeframes for the MAC to render their prior authorization decisions; and the subsequent claim submission process. CMS encourages participants to submit questions and feedback for incorporation into its supporting documents, such as the frequently asked questions document or the operational guide.

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.

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