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
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…
Medicare Changes to 5-Year PMD Prior Authorization Rule: Inside the Clinician Task Force Response to CMS
CTF Executive Director Tamara Kittelson said clinical assessments directly impact wheelchair provision outcomes.
Are you exactly the same person today — physically, cognitively, task wise — as you were five years ago? That’s the basic and critical question behind the Clinician Task Force’s (CTF) recent letter to the Centers for Medicare & Medicaid Services (CMS) concerning CMS’s recent change to the Medicare five-year replacement rule for prior authorization…
2026 Proposed Rule: CMS Recommends Annual DMEPOS Accreditation, Prior Authorization Changes
The changes were listed in the proposed rule for the calendar year 2026 home health prospective payment system.
The Centers for Medicare & Medicaid Services (CMS) wants Medicare durable medical equipment (DME) providers to be re-accredited annually, and also wants to change the prior authorization process for suppliers billing Medicare. The proposed changes were listed in the Calendar Year 2026 Home Health Prospective Payment System Proposed Rule Fact Sheet, CMS-1828-P, released June 30.…
Carelon Takeover of Medicaid Authorization for Maryland, Missouri, Wisconsin Now on Hold
Carelon was due to start handling prior authorization requests on July 1.
The July 1 transition that would have transferred prior authorization requests to Carelon Medical Benefits Management for Medicaid programs in Maryland, Missouri, and Wisconsin has been put on hold. In a June 28 bulletin, the American Association for Homecare (AAHomecare) said the transition “has been postponed until further notice. Suppliers in Maryland, Missouri, and Wisconsin…