Prior Authorization for Lower Limb Prostheses Codes
Linda Collins
08-07-2020
Blog
Effective September 1, 2020, Phase I of the Medicare pre-authorization program for 6 specific HCPCS codes will begin for suppliers in California, Michigan, Pennsylvania, and Texas. All other states will begin December 1, 2020.
Medicare Pre Authorization for Certain Lower Limb Prostheses Codes
Effective September 1, 2020, Phase I of the Medicare pre-authorization program for 6 specific HCPCS codes will begin for suppliers in California, Michigan, Pennsylvania, and Texas. All other states will begin on December 1, 2020.
You and your staff need to familiarize yourself with this process and plan to submit preauthorization for any claims containing one or more of the following HCPCS codes:
- L5856
- L5857
- L5858
- L5973
- L5980
- L5987
What does this mean for you?
- Pre Authorization will be required for dates of service on or after the effective date of Sept 1 or Dec 1, as appropriate for your state.
- Register with your DME MAC to utilize the online pre authorization submission.
www.cgsmedicare.com Region B, Region C
www.noridianmedicare.com Region A, Region D - The pre authorization submission must include the SWO, medical records and corroborating documentation.
- The DME MAC has 10 business days to review the request.
- Authorization letters will be sent to the mailing address on file with the NSC
- Once you receive authorization, you have 120 calendar days to provide the service.
- If the pre authorization request is denied, you may resubmit
- You will receive a Unique Tracking Number (UTN) which must then be included on the submitted claim.
- Electronic claims, the UTN is submitted in either the 2300 -Claim Information loop or 2400 -Service Line loop in the Prior Authorization reference (REF) segment where REF01 = “G1” qualifier and REF02 = UTN.
- Effective January 1, 2021, any product billed with these HCPCS codes must be listed on the PDAC website.
The following resources will be useful to you:
- Region B and Region C: https://www.cgsmedicare.com/jb/mr/llp_prior_auth.html
- Region A and Region D: https://med.noridianmedicare.com/web/portalguide/inquiry-guide/prior-authorizations
- Noridian Lower Limb Prostheses Prior Authorization Webinar https://register.gotowebinar.com/register/2383298514372020491