Prior authorization kicks in for two complex rehab codes

Tuesday, March 7, 2017

WASHINGTON – CGS and Noridian on March 6 began accepting prior authorization requests for K0856 and K0861 for providers in Illinois, West Virginia, Missouri and New York. They are accepting requests for dates of delivery on or after March 20. The two contractors have launched web pages on their websites with information on the process. For CGS’s, go here; for Noridian’s, go here. The contractors have also indicated that they plan to schedule new education on the process. Stakeholders are concerned with the lack of education going into the first phase of the program, which will expand nationwide July 17. CMS planned a special Open Door Forum on prior authorization for the two codes in January and then included it as an agenda item for a general forum in February, but never followed through with either.