Newly enrolled Medicare suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) will be on “probationary prior authorization for certain DMEPOS items” starting Oct. 15, according to an announcement from the Centers for Medicare & Medicaid Services (CMS).
DMEPOS businesses that have undergone “certain changes of ownership” on or after Oct. 15 are also included in the probationary prior authorization process.
CMS tied the probationary program to its ongoing antifraud efforts, saying, “This advance review helps to protect the Medicare trust fund from improper payments while ensuring that beneficiaries can receive the DMEPOS items they need in a timely manner.”
The impacted HCPCS codes are as follows (descriptions are abbreviated here):
E0747, E0748: Osteogenesis stimulators.
L0626, L0627, L0628, L0641, L0642: Lumbar orthoses.
L0630, L0633, L0635, L0643, L0649: Lumbar-sacral orthoses.
L0720: Cervical thoracic lumbar sacral orthoses.
L1652, L1653, L1686: Hip orthoses.
L1690: Combination, bilateral, lumbo-sacral, hip, femur orthosis.
L1810, L1812, L1820, L1821: Knee orthoses.
L1902: Ankle orthosis.
L1906, L1971: Ankle foot orthoses.
L2035, L2132, 2134, 2136: Knee ankle foot orthoses.
L3660, L3670: Shoulder orthoses.
L3760, L3762: Elbow orthoses.
L3809: Wrist hand finger orthosis.
L3908, L3915: Wrist hand orthoses
L3960: Shoulder elbow wrist hand orthosis.
L4360, L4361: Walking boots.
L4396, L4397: Static or dynamic ankle foot orthoses.
