Prior Authorization Exemptions: Opt-Out Extension
What You Need to Know
CGS and Noridian are extending their "opt-out" window for prior authorization exemptions from May 19, 2026 until May 26, 2026. As discussed in our previous post on Prior Authorization Exemptions, CMS is offering exemptions from the DMEPOS prior authorization program to any providers who meet the 90% provisional affirmation rate. The DME MACs sent out letters no later than April 2, 2026 to all qualifying providers, and these exempt providers will not be allowed to request prior authorization for any DMEPOS devices from June 1, 2026 until May 31, 2027, unless they opt out of the program.
What This Means for You
If CGS and/or Noridian sent you a prior authorization exemption letter and you want to continue submitting prior authorization requests, you must submit the opt-out form to the corresponding DME MAC between May 19, 2026, and May 26, 2026. All opt-out requests received after this period will be rejected. If you already submitted an opt-out form prior to the original April 30 deadline, then you do not need to submit a new request. You may complete the opt-out form using one of the following methods:
Noridian
- Send the Prior Authorization Exemption Status Opt Out Form via email ([email protected]) or the Noridian Medicare Portal
CGS
- Submit an opt-out request through myCGS (Claim Preparation > Prior Auth > Exemption Opt-Out Form); OR
- For Jurisdiction B, send the Prior Authorization for DMEPOS Exemption Opt-Out Request Form via Email ([email protected]) or Fax (615.660.5992); OR
- For Jurisdiction C, send the Prior Authorization for DMEPOS Exemption Opt-Out Request Form via Email ([email protected]) or Fax (615.664.5960)
For more information, visit the CGS and/or Noridian prior authorization exemption webpages.