01/21/2022 | Press release | Distributed by Public on 01/21/2022 11:38
The changes, many of which could affect PTs, will begin April 13. Now's the time to prepare.
Do you work with DMEPOS - durable medical equipment, prosthetics, orthotics, and supplies? The U.S. Centers for Medicare & Medicaid Services has some important news for you.
On Jan. 13, CMS issued multiple updates related to the Healthcare Common Procedure Coding System, or HCPCS, related to the master list of DMEPOS items that may require prior authorization, face-to-face encounters, or written orders, as well as lists of items that definitely require those measures. The announcement also includes items CMS has deleted from its master list.
It's a long list that isn't presented in a particularly easy-to-use format, but according to APTA Policy and Regulatory Affairs Senior Specialist Steve Postal, it should be required reading for any PT involved in DMEPOS.
"CMS updates these lists annually, but this particular revision includes a lot of items that could have a real impact on PTs," Postal said. "Providers need to familiarize themselves with the changes to avoid any surprise claim denials."
The changes published by CMS fit into one of three categories:
With an additional list of items deleted from the master list because they no longer meet minimum cost standards, CMS has published a total of five lists.
The entire list is too long to include here, but a wide range of items are covered, including dressings, pneumatic compressors, several types of neuromuscular stimulators, manual wheelchair accessories, power wheelchairs and parts, and multiple orthoses.
The updates will be effective April 13. Prior authorization will be phased in: the state from each of the four durable medical equipment Medicare administrative contractor areas with the highest utilization rates (New York, Illinois, Florida, and California) will begin April 13, with the next three-highest utilization states from each MAC area (Maryland, Pennsylvania, New Jersey, Michigan, Ohio, Kentucky, Texas, North Carolina, Georgia, Missouri, Arizona, and Washington) added beginning July 12. The system goes nationwide beginning Oct. 10.