Earlier this year, CMS began a prior authorization program for certain orthoses. Spinal Orthoses billed with HCPCS L0648 and L0650 plus Knee Orthoses billed with HCPCS L1832, L1833, and L1851 are now included in the prior authorization program.

• Phase 1 started on April 13, 2022, for patients in New York, Illinois, Florida, and California.
• Phase 2 started July 12, 2022, and after. Suppliers in Maryland, Pennsylvania, New Jersey, Michigan, Ohio, Kentucky, Texas, North Carolina, Georgia, Missouri, Arizona, and Washington may begin the prior authorization process on June 28, 2022, for dates of service July 12, 2022, or after.
• Phase 3 begins September 26, 2022 and will require all suppliers to use the process.

The DME MACs offer numerous resources including two upcoming webinars:

1. Noridian, Jurisdiction A and D, Sept 8th - Register here ›
    
2. CGS Medicare, Jurisdiction B and C, Monday, Sept 26th - Register here ›

What Does This Mean for You?

You must obtain prior authorization before you can dispense the brace. Learn more about the process, how to register on the site, and information about the required documentation HERE.

Register for one or both above webinars to learn more about the process and resources.