CMS has established a new prior authorization process for DMEPOS items that are frequently subject to unnecessary utilization. The final rule will create an initial Master list that includes items that meet specific criteria.
Items already on the Master List that are identified by a GAO/OIG, or CERT DME and/or DMEPOS Service Specific Report(s) will remain on the list for 10 years from the publication date of the new report(s).
REMINDER: A prior authorization decision is not a payment decision, and thus a prior authorization decision is not appealable.
Read the list of DMEPOS items meeting the proposed criteria and the Medicare Program; Prior Authorization Process for Certain Durable Medical Equipment.