Prior Authorization - Can it Be Transferred?
Medicare's prior authorization program requires suppliers to request authorization before delivering certain prosthetic and bracing devices. But what happens when a patient who was previously receiving care from another supplier switches to you and tells you that their previous supplier got authorization for the applicable prosthesis or orthosis? We'll give you the answer in this post.
What You Need to Know
Medicare's prior authorization program applies to a total of 11 L codes:
- Prosthetic: L5856, L5857, L5858, L5973, L5980, and L5987
- Orthotic: L0648, L0650, L1832, L1833, L1851
If you are providing an item described by one of these codes to a Medicare beneficiary, you must first obtain authorization to do so. Typically, you do this for claims involving an existing patient who comes to you for evaluation. That evaluation leads to clinical findings that you document and that form the basis of your prior authorization request.
But what happens when a patient switches to you for care after their previous supplier obtained authorization but before the previous supplier delivered the item to them? Can you proceed to deliver the item to the patient without filing your own authorization request?
Yes, you can - with one very important caveat. The prior authorization decision and the Unique Tracking Number associated with it are tied to the beneficiary, not the supplier. However, the supplier who received the authorization must transfer the UTN to you before you can proceed to delivery for the patient.
What this Means for You
If you have a patient who (a) comes to you from another supplier for an item described by one of the L codes listed above and who (b) states that they previously received authorization for the that item, you can deliver that item to the patient without seeking authorization yourself if you first get the previous supplier to transfer the UTN for that authorization request to you. However, if you cannot get the UTN transferred to you from the previous supplier, you would then have to go through the authorization process yourself.
For more information about prior authorization, please click the appropriate link for your DME MAC Region: Region A, Noridian; Region B, CGS; Region C, CGS; Region D, Noridian.