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Updated Prior Authorization Rules for DMEPOS

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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.

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