CMS Removes Prior Authorization Requirement for DMEPOS

April 2018 ~

In a rule finalized on March 30, prior authorization (PA) requirement for several types of medical equipment will be removed.

According to CMS, certain durable medical equipment prosthetics, orthotics and supplies, or DMEPOS, no longer meet the standards set forth in a 2015 final rule which required PA for DMEPOS that the agency characterizes as “frequently subject to unnecessary utilization” if the items meet a certain cost threshold.

The original cost threshold was set at an average purchase fee of at least $1,000 or an average monthly rental fee of at least $100, this amount is adjusted annually for inflation. After inflation adjustments for 2017 and 2018, the new thresholds will now be set at $1,018/purchase and $102/monthly rental.

Effective April 30, CMS will remove the following four Healthcare Common Procedure Coding System (HCPCS) codes from the current “Master List of Items Frequently Subject to Unnecessary Utilization:”

  • E0260 – Hospital bed semi-electric (head and foot adjustment) with any type side rails with mattress
  • E0601 – Continuous Airway Pressure (CPAP) Device
  • E1390 – Oxygen Concentrator
  • K0004 – High strength, lightweight wheelchair

View the full Prior Authorization Process for Certain Durable Medical Equipment, Prosthetic, Orthotics, Supplies (DMEPOS) Items update, here.



Source(s): Health Industry Washington Watch; Federal Register; CMS;