REMINDER: Medicare Prior Authorization Changes Coming April 13
Starting next Monday, seven new HCPCS codes will require prior authorization from Medicare. This article will review the upcoming changes, as previously discussed in our February 4 R&R post.
What You Need to Know
CMS will require prior authorization for 7 additional HCPCS codes, including 2 pneumatic compression device codes and 5 orthotic HCPCS codes, for any claims with a date of service on or after April 13, 2026. Here is a complete list of ALL orthotic and prosthetic codes that will require prior authorization starting next week (newly added codes are in bold):
Prior Authorization
- LSOs: L0631, L0637, L0639, L0648, L0650, and L0651
- Knee Orthoses: L1832, L1843, L1844, L1845, L1846, L1851, and L1852
- AFOs: L1932 and L1951
- Prosthetics: L5856, L5857, L5858, L5973, L5980, and 5987
What This Means for You
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 March 30, 2026. Therefore, if you anticipate billing HCPCS code L0651, L1844, L1846, L1852, or L1932 for a patient scheduled on or after April 13, 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, you can review the following articles posted by the DME MACs:
Noridian
CGS