Federal Register #2026-15446

CMS Updates Master List of DMEPOS Items Requiring Face-to-Face, Written Order, and Prior Authorization

CMS has released an update to the Master List of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items subject to face-to-face encounter, written order, and prior authorization requirements. - Government Buyer: - Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services - Products/Services Requested: - 20 new HCPCS-coded DMEPOS items added to the Master List - Examples include: - Supply allowance for continuous glucose monitors (A4239) - Neuromodulation stimulator systems (A4594) - Collagen and alginate wound dressings (A6022, A6197) - Segmental pneumatic appliances (E0658, E0659) - Peristaltic wave compression pumps (E0683) - Upper limb tremor stimulators (E0734) - Upper extremity rehabilitation systems (E0738, E0739) - Home suction pumps (E2001) - Power wheelchair accessories and seat elevators (E2298, K0831) - Thoracic-lumbar-sacral and knee orthoses (L0456, L0486, L1833) - Ankle foot orthoses (L1933, L1952) - Wrist hand orthoses (L3916) - No specific OEMs or vendors are named; items are identified by HCPCS codes - Unique/Notable Requirements: - Items are selected based on payment thresholds, aberrant billing patterns, and findings from GAO/OIG reports - Phased implementation for prior authorization of upper limb orthoses, starting in select states and expanding nationwide - Focus on reducing fraud and improper payments in Medicare - OEMs: - Not specified; products are referenced by generic HCPCS codes, not by manufacturer

Description

This document announces updates to the Healthcare Common Procedure Coding System (HCPCS) codes on the Master List. It also announces updates to the HCPCS codes on the Required Face-to-Face Encounter and Written Order Prior to Delivery List and the Required Prior Authorization List. The updates include additions of new HCPCS codes based on criteria such as payment thresholds, aberrant billing patterns, and reports identifying high rates of fraud or unnecessary utilization. Implementation of these updates, excluding upper limb orthoses, is effective October 28, 2026, with phased implementation for upper limb orthoses.

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