The Centers for Medicare & Medicaid Services (CMS) recently issued two new regulations that impact patient access to O&P care. On December 28, 2021, CMS issued a long-delayed final rule implementing various proposals related to benefit category determinations (BCDs) and pricing decisions for new O&P technologies. On January 13, CMS published a new rule updating the Healthcare Common Procedure Coding System (HCPCS) codes on the Required Prior Authorization List, the Required Face-to-Face Encounter and Written Order Prior to Delivery List (Face-to-Face List), and the Master List of HCPCS codes potentially subject to these requirements.1 This article summarizes these important new rules.
Benefit Category and Pricing Determinations
