CMS Postpones O&P Prior Authorization, Makes Policy Changes

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The Centers for Medicare & Medicaid Services (CMS) announced that it will pause the prior authorization program for the national Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS). Prior authorization for six lower-limb prosthesis codes (L-5856, L-5857, L-5858, L-5973, L-5980, and L-5987) was scheduled for implementation in Pennsylvania, Michigan, Texas, and California on May 11, and rolled out nationwide on October 8.

CMS also announced the following policies in response to COVID-19:

·        CMS is not requiring accreditation for newly enrolling DMEPOS suppliers and is extending any expiring supplier accreditation for 90 days.

·        CMS is waiving signature and proof of delivery requirements for Durable Medical Equipment when a signature cannot be obtained because of the inability to collect signatures. Suppliers should document in the medical record the appropriate date of delivery and that a signature was not able to be obtained because of COVID-19.

·        In order to increase cash flow to providers impacted by COVID-19, CMS has expanded its Accelerated and Advance Payment Program. An accelerated/advance payment is a payment intended to provide necessary funds when there is a disruption in claims submission and/or claims processing. CMS is authorized to provide accelerated or advance payments during the period of the public health emergency to any Medicare provider/supplier who submits a request to the appropriate Medicare Administrative Contractor (MAC) and meets the required qualifications. Each MAC will work to review requests and issue payments within seven calendar days of receiving the request. Traditionally repayment of these advance/accelerated payments begins at 90 days, however for the purposes of the COVID-19 pandemic, CMS has extended the repayment of these accelerated/advance payments to begin 120 days after the date of issuance of the payment.

To read the CMS announcement, Durable Medical Equipment, Prosthetics, Orthotics and Supplies: CMS Flexibilities to Fight COVID-19, visit CMS.