Changes Effective August 12, 2024

When Did CMS Announce the Updates?

Updates announced July 18, 2024

1.  Master List of DMEPOS Items

• The Master List of DMEPOS Items was updated in 2022, expanding to include 439 items. This 2024 document is the most recent version. 

2. Face-to-Face Encounter and Written Order Authorization (Prior to Delivery) List 

• CMS has expanded the F2F/WOPD List by adding 13 additional HCPCS codes for specific medical equipment such as hospital beds, osteogenesis stimulators, and lumbar-sacral and knee orthoses to improve oversight and reduce fraud.
• Note: A face-to-face meeting with the treating practitioner is now required within six months prior to issuing a written order or prescription for these designated items.  

3.  Required  Prior Authorization List 

• CMS has updated prior authorization requirements for HCPCS codes, adding nine new codes and removing one.
• The remaining 61 HCPCS codes on the required prior authorization list remain unchanged.
• After the review process, decisions on provisional affirmation or non-affirmation will be communicated to the requester. 
• New required prior authorizations for newly-added lumbar-sacral and lower limb orthoses.
• The prior authorization of newly added osteogenesis stimulators will be implemented in two phases.
• Phase 1 - effective 8/12/2024, will include California, Florida, Ohio, and Pennsylvania.
• Phase 2 - effective 11/12/2024, will consist of all remaining U.S. states and territories not included in Phase 1. 

Resources

• DMEPOS Master List
• Face-to-Face Encounter and Written Order Authorization Prior-to-Delivery List
• Prior Authorization List
• Federal Register Document - Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) 

Each year, CMS adjusts the "payment threshold" to account for inflation, and the DMEPOS fee schedule amounts are also updated annually. In the latest update, CMS added  76 HCPCS codes to the Master List. Items are removed from the Master List 10 years after the date they were added unless they meet specific criteria or if their purchase or monthly rental amount drops below the payment threshold. 

As an credentialing organization (BOC), works to inform you of important changes that may impact your business and the patients you serve. If you have questions about this update, contact Legislative and Advocacy Affairs Specialist, JaNay Covin.