The Centers for Medicare & Medicaid Services (CMS) has added HCPCS codes for orthoses and pneumatic compression devices (PCDs) to the Medicare list of durable medical equipment requiring prior authorization.
Prior authorization requirements go into effect on April 13, 2026.
The orthotic codes impacted are:
L0651: Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to T9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated, off-the-shelf.
L1844: Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated.
L1846: Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated.
L1852: Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf L1852
L1932: Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise.
The PCD codes impacted are E0651 (pneumatic compressor, segmental home model without calibrated gradient pressure) and E0652 (pneumatic compressor, segmental home model with calibrated gradient pressure).
CGS Administrators, the Jurisdictions B and C DME MAC, indicated in a Feb. 2 announcement that it will begin accepting prior authorization requests for the codes on March 30. CMS has also said in an FAQ document updated Jan. 13 that DME MACs would start accepting prior authorization requests on that date.
