CMS Announces Prior Authorization Open Door Forum for Support Surfaces

• By Laurie Watanabe
• May 29, 2019

The Center for Medicare & Medicaid Services (CMS) has announced a special Open Door Forum to discuss prior authorization plans for pressure-reducing support surfaces.

The conference call will take place Tues., June 4, from 2 p.m. to 3 p.m. Eastern time and will be hosted by the Center for Program Integrity.

In April, CMS added five HCPCS codes to the prior authorization list. The codes are E0193 (Powered air floatation bed/low air loss therapy); E0277 (Powered pressure-reducing air mattress); E0371 (Nonpowered advance pressure-reducing overlay for mattress length and width); E0372 (Powered air overlay for mattress, standard mattress length and width); and E0373 (Nonpowered advanced pressure-reducing mattress).

CMS intends to roll out the prior authorization program in two phases. The first — for California, Indiana, New Jersey and North Carolina — begins July 22, 2019. Phase two is scheduled to start Oct. 21, 2019, and will expand prior authorization for those codes to remaining states and territories.

Topics to be discussed at the Open Door Forum include the process for submitting prior authorization requests and the timeframes for the DME MACs to respond with their decisions.

“Prior authorization helps ensure all relevant coverage, coding and clinical documentation requirements are met before the item is furnished and before the claim is submitted for payment,” CMS said in a May 29 bulletin to stakeholders. “Prior authorization also certifies that payment of DMEPOS items is appropriate, thereby working toward the prevention and identification of potential fraud, waste and abuse; the protection of the Medicare Trust Funds from improper payments; and the reduction of Medicare appeals.”

To attend the conference call, dial (800) 837-1935, and use participant number 5960428.