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…
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…
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…
Ultralightweight Frame Upgrade Bill Heads to Full Committee Following Markup
The Choices for Increased Mobility Act will be considered by the Energy & Commerce committee in the U.S. House.
[Updated May 22] The American Association for Homecare (AAHomecare) reported May 22 that H.R. 1703 passed the U.S. House’s Energy and Commerce committee with a unanimous 45-0 vote on May 21. The House bill that would provide a clearer path for Medicare beneficiaries to upgrade to titanium or carbon fiber frames for their ultralightweight wheelchairs…
Mobility Management Webinar: Optimizing Reimbursement with Clinical, Intake Best Practices
The presentation, sponsored by ACU-Serve, is free to attend.
Yes, wheels make the wheelchair go round in Complex Rehab Technology — but getting those wheels rolling requires proper reimbursement. And that reimbursement hinges on providing the right documentation in an efficient and accurate way. Our May 19 webinar — Clinical and Intake Best Practices: Optimizing Reimbursement, sponsored by ACU-Serve, will discuss the best ways…
Commentary: 4 Takeaways from the DME MAC PMD/Seat Elevation LCDs Meeting
Individual consideration, prior authorization and other key talking points from the March 25 virtual event.
If our same-day coverage of the March 25 DME MAC-hosted local coverage determinations (LCDs) meeting for power mobility devices and seat elevation was TL;DR — here are the highlights, as well as our take on their potential impact. — It’s all about preserving individual consideration and access. The DME MACs — Noridian Healthcare Solutions (Jurisdictions…