CMS Finalizes Prior Authorization Program For Certain DMEPOS Items

On December 30, 2015, the Centers for Medicare & Medicaid Services (CMS) published its final rule establishing a prior authorization program for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) items frequently subject to unnecessary utilization (the Final Rule). As noted in our commentary on the proposed rule  the Final Rule creates a "Master List" of items that could require prior authorization as a condition of Medicare payment as well as a subset list of items for which prior authorization is required. The provisions of the Final Rule are effective on February 29, 2016.

Master List

The Master List of DMEPOS items that could be subject to prior authorization includes items frequently subject to "unnecessary utilization," which is defined as "the furnishing of items that do not comply with one or more of Medicare's coverage, coding, and payment rules."  The Final Rule creates an initial Master List of 135 items that are listed on