Tag: prior authorization

ATLANTA - CMS plans to update the Federal Register today to add certain L codes to the prior authorization list for DMEPOS, according to the van Halem Group.CMS will add the following codes to the list of items that require prior authorization as a condition of payment:L5856 - (Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type)L5857  - (Addition to lower extremity prosthesis,...

WASHINGTON - A prior authorization requirement for Group 2 pressure reducing support surfaces will expand to all states and territories effective Oct. 1. Prior auths for dates of delivery on or after July 22 were already in effect in California, Indiana, New Jersey, and North Carolina for E0193, E0277, E0371, E0372 and E0373. CMS announced the addition of the codes to the national prior authorization program in April, along with seven additional codes for complex rehab power mobility devices. During...

WASHINGTON - CMS has added seven codes for complex rehab power mobility devices and five codes for support surfaces to the national prior authorization program, AAHomecare reports.The agency will roll the PMD codes into the program within 90 days, or July 21 by the association's estimates.The support surface codes will added in two phases, within 90 days in California, Indiana, New Jersey and North Carolina, and within 180 days, or Oct. 19, 2019, by AAHomcare's estimates, in all states.The codes...

WASHINGTON - CMS has published guidance for power mobility device providers on the transition to the national prior authorization program. “Inclusion of Power Mobility Device Codes in the Prior Authorization Program for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items” lists all the HCPCS codes that will be included in the program starting Sept. 1, according to a bulletin from AAHomecare. For states not currently in the demonstration, the MACs will start accepting...

WASHINGTON - CMS will roll the standard power mobility device codes that are currently part of a PMD Prior Authorization Demonstration in 19 states into the National Prior Authorization Program on Sept. 1, the agency announced late on Friday.The PMD PA Demo was due to expire Aug. 31. Industry stakeholders have been lobbying CMS to expand the prior authorization requirement for PMDs to all states and to also apply it to complex rehab wheelchairs.Currently, there are only two codes in the National...

WASHINGTON - CMS should continue with its prior authorization programs and expand prior authorizations to include power wheelchair accessories, according to a new report from the Government Accountability Office.The prior authorization demonstration project launched in seven states in 2012 and was expanded to an additional 12 states in 2014. Originally set to expire Aug. 31, 2015, the deadline was pushed to Aug. 31, 2018 and CMS has not announced plans to extend the deadline again.The GAO estimates...

WASHINGTON - AAHomecare's Complex Rehab & Mobility Council is collecting feedback from providers about the prior authorization demonstration project for power mobility devices currently taking place in 19 states. Responses to the council's brief online survey are due by May 25. “The PMD prior authorization program has been a win-win for the HME industry and for CMS, and information from this survey will bolster our efforts in working toward a nationwide, permanent prior authorization program...

WASHINGTON - It looks like CMS plans to extend a demonstration project requiring prior authorizations for power mobility devices, according to a notice posted in the Federal Register on Feb. 7. The demo, in place in 19 states, is set to expire at the end of August. The Paperwork Reduction Act of 1995 requires federal agencies to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of...

YARMOUTH, Maine - The big story in mobility for 2017 was CMS's new prior authorization program for two complex rehab codes, K0856 and K0861.Authorize thisPrior authorizations were the subject of two of the most read stories for 2017: “CMS announces first codes up for PA process” (No. 2) and “It's a bumpy start for prior authorizations” (No. 4).Mobility providers are no strangers to prior authorizations, which CMS already requires in 19 states for standard power wheelchairs...

PIERRE, S.D. - South Dakota has joined the prior authorization bandwagon, but there's a wrinkle.On Jan. 1, South Dakota's Medicaid program began requiring prior authorizations for most mobility devices, as is the case for Medicaid programs in most states and for Medicare in a number of states. But South Dakota will also require prior authorizations for repairs or replacement of parts or accessories.“Our main concern is for the repairs,” said Cindy Coy, the business office manager...