Medicare claims for ultralightweight manual wheelchairs (HCPCS code K0005) with dates of service of Oct. 28 or later will need to go through the prior authorization process. The July 30 edition of the Federal Register listed eight HCPCS codes, including K0005, that will be required to use prior authorization. The other codes are E0194 (air…
K0005 Update: Medicare Prior Authorization to Be Required Starting in Late October
Upcoming CRT Awareness Week to Promote Value of CRT
Awareness Week is Sept. 14-18.
This year’s Complex Rehab Technology (CRT) Awareness Week — Sept. 14-18 — will focus on building support for S. 247, the Choices for Increased Mobility Act currently in the U.S. Senate. The bill, introduced in January by Senators Marsha Blackburn (R-Tenn.) and Tammy Duckworth (D-Ill.), is a companion to House bill H.R. 1703, which passed…
House Passes Ultralightweight Frame Upgrade Bill; Focus Moves to Senate
The Choices for Increased Mobility Act passed the U.S. House by voice vote on July 20.
Now that H.R. 1703, the Choices for Increased Mobility Act, has passed the U.S. House of Representatives, the Complex Rehab Technology industry’s focus shifts to the Senate, which has its own version of the bill (S. 247). The bills, which are both budget neutral, expand access to titanium and carbon fiber ultralightweight wheelchair frames by…
Medicare Proposed Rule: Eliminate Face-to-Face Requirement for Replacement DMEPOS
While a rule change could save time, replacing durable medical equipment without a new evaluation also raises concerns.
The new prospective payment system proposed rule from the Centers for Medicare & Medicaid Services (CMS) is clarifying that a face-to-face examination is not always needed for replacement durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) orders. CMS also released a fact sheet on July 1, the same day as the Calendar Year 2027 Home…
DMEPOS Suppliers Lead Medicare in Improper Payment Errors: MedPAC
The error rate for DMEPOS suppliers reached 24.2%, nearly four times the overall Medicare fee-for-service improper payment rate.
Providers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) posted the highest improper payment rate among all Medicare provider types in fiscal 2025, with documentation failures driving the majority of errors that cost the federal program billions of dollars. The error rate for DMEPOS suppliers reached 24.2%, which was nearly four times the overall…
CMS Announces Increased Oversight of Accrediting Organizations
A new final rule and fact sheet focus on avoiding conflicts of interest between accrediting organizations and providers.
The Centers for Medicare & Medicaid Services (CMS) is strengthening its oversight of organizations that accredit Medicare durable medical equipment suppliers, including those that provide Complex Rehab Technology. A June 12 fact sheet from CMS focused on the obligations of accrediting organizations (AOs) that survey Medicare and Medicaid suppliers. In the fact sheet, CMS emphasized…
New Webinar: The Impact of Anti-Fraud Measures on DME, Home Health, Hospice Providers
June 23 event will discuss how Centers for Medicare & Medicaid Services’ actions are affecting businesses and patients.
Mobility Management and HME Business will bring together experts from durable medical equipment (DME), home health and hospice to discuss the Centers for Medicare & Medicaid Services’ (CMS) recent anti-fraud measures — and how Medicare beneficiaries in all three segments are being impacted. The June 23 webinar — Fraud in Focus: What CMS’s Moratoria and…
DME MACs Implement New Medicare Prior Authorization Policy
The new prior authorization policy began June 1.
CGS Administrators, the jurisdictions B and C DME MAC, has published a prior authorization reminder to home medical equipment suppliers who bill Medicare. As of June 1, exempt suppliers — defined as suppliers who didn’t opt out of the process — should have stopped submitting prior authorization requests to the DME MACs “All other suppliers…
Patient Organizations: Medicaid Interim Final Rule Will Cause Massive Coverage Loss
Advocacy groups are also concerned about documentation burdens.
Healthcare organizations — including a group of 48 nonprofit, nonpartisan patient associations — are expressing concern over the Centers for Medicare & Medicaid Services’ (CMS) interim final rule requiring “80 hours per month of qualifying activities, such as employment, participation in certain work programs, or community service, or [enrollment] in educational programs at least half…
Medicaid Interim Final Rule Spells Out Work Requirements, Exemptions
Interim rule provisions are effective July 31, 2026.
The Centers for Medicare & Medicaid Services’ (CMS) new interim final rule will implement “a new statutory requirement for certain adults in Medicaid to meet an 80-hours-per-month work requirement — sometimes referred to as Medicaid community engagement — as a condition of eligibility.” In its June 1 announcement, CMS said states “must generally implement this…