On February 11, we notified you that the Centers for Medicare and Medicaid Services (CMS) had announced that six lower limb prosthetic codes will be added to the codes that require Medicare prior authorization as a condition of payment. The full notification can be found here.
AOPA has continued to monitor communications from CMS and the DME MAC contractors regarding the Medicare prior authorization process. To that end, the CMS Center for Program Integrity will hold a Special Open Door Forum – Prior Authorization Process for Certain Durable Medical Equipment Prosthetics, Orthotics and Supplies Items: Inclusion of Lower Limb Prosthetics in Prior Authorization on Wednesday, March 11 from 2 – 3pm ET. During this conference call, they will outline the process for submitting a prior authorization request to the designated DME MAC, the timeframes for the DME MAC to render their prior authorization decisions, and the process for subsequent claim submissions. Participants will be encouraged to submit questions or provide feedback.
AOPA will attend and provide updates to membership. If you want to attend, information on how to participate is available here.
AOPA remains encouraged by CMS’ transparency regarding prior authorization and will continue closely monitor developments and provide updates to the membership. Additionally, look for information on education AOPA will be providing to members regarding the prior authorization process.
Questions regarding this issue may be directed to Joe McTernan at jmcternan@aopanet.org or Devon Bernard at dbernard@aopanet.org.