REMINDER: Medicare Prior Authorization and WOPD Changes Coming August 12
In less than two weeks, six new orthotic HCPCS codes will require prior authorization and eight new orthotic HCPCS codes will require a WOPD and face-to-face encounter. This article will review the upcoming changes, as previously discussed in our May 22 R&R post.
What You Need to Know
On May 13, 2024, CMS announced updates to both the Required Prior Authorization List and Required Face-to-Face and WOPD List. Starting on August 12, 2024, Medicare will no longer require prior authorization or a WOPD for knee orthoses billed using HCPCS code L1833. Along with this deletion, CMS also added 9 new HCPCS codes to the prior authorization list (including 6 orthotic codes) and 13 new HCPCS codes to the WOPD list (including 8 orthotic codes). Here is a complete list of ALL orthotic and prosthetic codes that will require prior authorization and/or a face-to-face encounter with WOPD starting on August 12, 2024 (newly added codes are in bold):
Prior Authorization
- LSOs: L0631, L0637, L0639, L0648, and L0650
- Knee Orthoses: L1832, L1843, L1845, and L1851
- AFOs: L1951
- Prosthetics: L5856, L5857, L5858, L5973, L5980, and 5987
Face-to-Face and WOPD
- LSOs: L0631, L0635, L0636, L0637, L0638, L0639, L0640, L0648, L0650, and L0651
- Knee Orthoses: L1832, L1843, L1845, L1851, and L1852
- AFOs: L1932, L1940, L1951, L1960, and L1970
- KAFOs: L2005 and L2036
- SEWHOs: L3960
What this Means for You
Prior to August 12, 2024, take time to prepare your clinics for the changes summarized above. Along with educating your staff, you should also discuss office protocol and workflow to ensure that the appropriate documents are requested and received prior to delivery. To help prevent delays, the DME MACs announced that they will begin accepting prior authorization requests for the newly added codes on July 29, 2024. Therefore, if you anticipate billing HCPCS code L0631, L0637, L0639, L1843, L1845, or L1951 for a patient scheduled on or after August 12, then you can submit your authorization request to Noridian/CGS today. With this being said, it is important to remember that medical necessity must be met and documented at the time authorization is requested. For further information, review the following articles posted by the DME MACs:
Noridian
CGS