While a previous blog discussed some of the changes the Centers for Medicare and Medicaid Services (CMS) had made to HCPCS codes for certain oxygen codes, the organization is already planning to enact changes to other areas in the near future. As of April 30th, CMS will no longer require prior authorization for four specific HCPCS Level II codes pertaining to DME, or durable medical equipment.

These updates come as changes to the CMS master list, a comprehensive list officially titled the Master List of Items Frequently Subject to Unnecessary Utilization. Developed in 2015, this list, which is updated every year, contains all available types of durable medical equipment, prosthetics, orthotics, and supplies, which is usually shortened to DMEPOS for convenience. To be on this list, these items must meet certain criteria as outlined below.

  • They must be on the DMEPOS fee schedule list.
  • They must have an average monthly rental price of $100 or an average purchase price of $1000.
  • They must either A.) have a high rate of fraud or unnecessary use, or B.) be listed in the Comprehensive Error Rate Testing (CERT) program’s annual report for improper fee for service payment and/or the DMEPOS Specific Service Report.

Since they no longer exceed the payment threshold, the following four codes will no longer need to be preauthorized:

  • E0260: Hospital bed semi-electric (head and foot adjustment) with any type side rails with mattress
  • E0601: Continuous air pressure (CPAP) device
  • E1390: Oxygen concentrator
  • K0004: High-strength lightweight wheelchair

If your practice regularly uses and prescribes DMEPOS products, then be sure to familiarize yourself and your coworkers with these updates. Because the Master List changes annually, it is a good idea to get used to checking it for updates so that you can provide the most accurate and precise code assignment to all patients no matter their issue.