Tag: Prior Authorization
AffirmDME offers guide for new codes added to prior auth list
October 20, 2026HME News Staff
LAS VEGAS – AffirmDME has released documentation checks and public requirement guides for the eight HCPCS codes that the Centers for Medicare & Medicaid Services (CMS) will add to its Required Prior Authorization List on Oct. 28. "Suppliers do not fail these reviews on medical necessity; they fail them on a document that is missing or dated wrong," said Nicholas Fortner, founder of AffirmDME. "We put the requirement list where the packet gets built, and we published the same...
United Spinal’s ROCH provides momentum to wheelchair repair bill
August 28, 2026Liz Beaulieu, Editor
WASHINGTON – The United Spinal Association says advocacy efforts during its annual Roll on Capitol Hill (ROCH) event have already helped secure new congressional support for legislation that would prohibit Medicare Advantage plans from requiring prior authorization for maintenance and repairs to wheelchairs and other complex rehab technology.
Following 172 meetings with congressional offices during the late-June event, Reps. Joe Wilson, R-S.C., and Jonathan Jackson, D-Ill., signed on as...
Prior authorization metrics provide new insight, KFF says
August 18, 2026HME News Staff
WASHINGTON – Medicare Advantage insurers denied 13% of standard prior authorization requests, Medicaid managed care insurers denied 14% and ACA Marketplace insurers denied 18%, according to a new analysis from KFF.
Insurers were required to post the first year of prior authorization metrics for the 2025 calendar year by March 31, 2026. KFF collected and analyzed these metrics from the largest insurers in most market segments for which reporting is required.
Other key takeaways from the...
In brief: ReDream Brands launch, CMS contract count, prior auth denials
August 14, 2026HME News Staff
NEW YORK – Cathay Capital has announced the launch of ReDream Brands, a new consumer health platform that brings together four direct-to-consumer brands: cpap.com, The CPAP Shop, Lofta and sleeping.com.
The launch follows a series of strategic transactions executed by Cathay Capital-backed cpap.com, including the formation of a joint venture with AdaptHealth bringing together cpap.com, sleeping.com, and The CPAP Shop, along with the subsequent acquisition of Lofta. The transactions were...
CMS updates requirements for certain codes starting Oct. 28
August 6, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has updated the required face-to-face and written order prior to delivery list to include the following codes, AAHomecare reports:
Mobility: E1161, K0002, K0003, K0004, K0005, K0006, K0007, K0831
Respiratory: E0466, E0467, E0468
Orthosis: L0486, L0456, L0457, L1833, L1906, L1933, L1952, L3761, L3916
Pressure reducing support surfaces: E0194
Starting Oct. 28, these items will require a documented face-to-face encounter...
California removes certain requirements for wheelchair repairs
August 4, 2026HME News Staff
SACRAMENTO, Calif. – The California Department of Health Care Services will not require treatment authorization requests (TARs) when the cumulative cost for wheelchair repair maintenance or replacement parts is less than or equal to $2,500 within a calendar month, the National Coalition for Assistive & Rehab Technology (NCART) has announced. “NCART members, consumers, and the California Department of Health Care Services have been meeting to improve the CRT benefit for California consumers,”...
In brief: Aeroflow & Canopie, prior auth relief, massive fraud takedown
June 26, 2026HME News Staff
ASHEVILLE, N.C. – Aeroflow Health has acquired Canopie, a digital health company that provides virtual preventative care programs for expecting and new moms, with a focus on mental health and physical wellness.
Aeroflow already connects moms with lactation supplies, feeding support, and perinatal education through its flagship business, Aeroflow Breastpumps.
"Supporting mothers through every stage of pregnancy, postpartum, and beyond has always been our vision, not just through products,...
Bill seeks to eliminate prior authorization for wheelchair repairs
June 25, 2026HME News Staff
WASHINGTON – Rep. Ayanna Pressley, D-Mass., has introduced legislation that would remove prior authorization requirements from Medicare Advantage plans for maintenance and repairs to wheelchairs and other complex rehab technology (CRT).
“When a wheelchair breaks down, daily life is disrupted,” said Pressley. “I’m grateful to my constituents and our disability justice advocates for informing this vital legislation.”
Pressley announced the “Facilitating...
AAHomecare throws weight behind Medicare Advantage reforms
June 19, 2026HME News Staff
WASHINGTON – AAHomecare has sent letters of support to the sponsors of legislation in the House and Senate that would reform Medicare Advantage prior authorization, claims integrity and transparency.
In its letters to Rep. John Joyce, R-Pa., and Sen. Roger Marshall, R-Kan., the organization shared how the bills would address challenges that home medical equipment (HME) providers face daily and would improve access to medical necessary equipment for Medicare beneficiaries.
“These...
CRT providers wrangle with repairs and prior auth exemption
June 19, 2026Liz Beaulieu, Editor
WATERLOO, Iowa – Complex rehab technology (CRT) providers continue to face persistent challenges with documentation and billing for wheelchair repairs, according to Dan Fedor of U.S. Rehab, who addressed the issue at the recent VGM Heartland Conference.
Fedor, director of reimbursement and education for U.S. Rehab, a division of VGM & Associates, said repairs remain one of the most common operational pain points for providers – accounting for roughly 30% of his daily communications...