Prior authorization changes coming for durable medical equipment: 5 things to know

Beginning in May, CMS is changing its prior authorization requirements for six additional items of durable medical equipment, prosthetics and orthotics.

Five things to know:

1. The update, finalized in February, will add six codes for lower-limb prosthetics to the required prior authorization list.

2. The six codes are L5856, L5857, L5858, L5973, L5980 and L5987.

3. CMS is implementing the change in two phases, with phase one beginning May 11 in the following states: California, Michigan, Pennsylvania and Texas.

4. Phase two starts Oct. 8 and expands prior authorization of the six codes to all remaining states.

5. Joe McTernan, director of coding and reimbursement services, education, and programming at the American Orthotic & Prosthetic Association, told HME News, "The [prior authorization] process, as a concept, is not one that AOPA is necessarily against, but we have been and remain concerned that if it is not done effectively and fairly, that patients will, ultimately, be the ones who suffer through reduced access to medically necessary, high-quality clinical care."

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