UPDATE: Prior Authorization for HCPCS L0648, L0650, L1832, L1833 and L1851
Effective today for HCPCS codes L0648, L0650, L1832, L1833 and L1851
Today the Medicare Prior Authorization process for products billed with the above mentioned HCPCS codes begins for providers in California, Illinois, New York and Florida.
Also, today, CMS announced that items provided under those billing codes that are required to be dispensed immediately to avoid delaying care and health risks on a patient, do not require prior authorization.
CMS has provided guidance indicating that braces dispensed in an urgent/emergent situation must be billed with an ST modifier. These claims will not require prior authorization. Be aware, claims with the ST modifier WILL be subject to prepayment review.
This means the claim will not be immediately paid, the provider will be asked to submit medical documentation supporting the immediate need of the brace, and a determination made prior to payment being released.
The ST modifier is to be used in addition to any other required modifiers, including LT, RT and the Competitive Bid modifier of KV.
What Does This Mean for You?
When you see a patient who needs a back or knee brace, billed with HCPCS L0648, L0650, L1832, L1833 or L1851, who needs a brace immediately, you can dispense the brace and bill the claim using the ST modifier.
Make sure the medical record documentation details the need for the brace immediately and what healthcare conditions are being treated.
Be prepared to submit these records to CMS for review upon request prior to receiving payment.