Implementation of Prior Authorization for LLP
Previously CMS announced the addition of 6 LLP HCPCS to be included in the prior authorization program. Recently, CMS announced this program will start on May 11, 2020 for suppliers in California, Michigan, Pennsylvania, and Texas.
Previously CMS announced the addition of 6 LLP HCPCS to be included in the prior authorization program. Recently, CMS announced this program will start on May 11, 2020 for suppliers in California, Michigan, Pennsylvania, and Texas.
All suppliers who bill one of the 6 LLCP HCPCS to Medicare, will begin the prior authorization program on October 8, 2020.
The HCPCS identified for prior authorization are:
- L5856
- L5857
- L5858
- L5973
- L5980
- L5987
What does this mean?
Once implemented, you will need to submit a prior authorization request to the DME MAC for your region. The request must include a physician’s order (SWO), copies of medical records, and other clinical documentation that supports medical necessity. The submitted materials will be compared to the coverage requirements outlined in the Lower Limb Prostheses LCD (L33787) and Policy Article (A52496)
What do you need to do?
Make sure you and your staff understand the coverage requirements for these products as stated in the LCD and Policy Article.
Check the MAC sites for upcoming educational webinars on the new prior authorization program.
Keep reading R&R and we will update you with details as they are released.