Effective immediately, CMS will delay phase one for prior authorization of Osteogenesis Stimulators HCPCS codes (E0747, E0748, and E0760) until September 17, 2024. Previously, these codes were scheduled to be added to the Required Prior Authorization List in the states of California, Florida, Pennsylvania, and Ohio on August 12, 2024. Phase two for prior authorization of osteogenesis stimulators will remain the same, and prior authorization will be required for all states beginning November 12, 2024. For more information, please visit CMS Delays Prior Auth
Medicare Competitive Bidding AnnouncemeNT
All Medicare Round 2021 Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Competitive Bidding Program (CBP) Contracts for Off-the-Shelf (OTS) back braces and OTS knee braces expire on December 31, 2023. Starting January 1, 2024, there will be a temporary gap in the DMEPOS CBP.
The Centers for Medicare & Medicaid Services plans to conduct bidding for the next round of the DMEPOS CBP after going through notice and comment rulemaking to further strengthen the DMEPOS CBP.
For additional information on the gap period, please see the Temporary Gap Period (PDF) fact sheet and continue to monitor the CMS.gov and Competitive Bidding Implementation Contractor (CBIC) websites for updates.
Please click this link for more information:
durable medical equipment, prosthetics,orthotics and supplies (dmepos) order requirements
On January 17, 2023, a second Federal Register Notice was published that announced 10 additional orthoses that will require a face-to-face encounter and written order prior to delivery as a condition of payment. Therefore, effective April 17, 2023, a total of 63 items are now on the face-to-face encounter and written order prior to delivery List.
Standardized DMEPOS Written Order/Prescription
Any Medicare provider or supplier that writes DMEPOS orders or prescriptions will now use a standard set of elements that will be applicable to all DMEPOS items.
- Beneficiary name or Medicare Beneficiary Identifier (MBI) Number
- Description of the item
- Quantity, if applicable
- Treating practitioner name or National Provider Identifier (NPI)
- Date of the order
- Treating practitioner signature
The treating practitioner must submit the complete written order to the supplier prior to submitting a claim for Medicare payment.
A successful 2023 starts with ensuring your clinic or ASC has the best DME SaaS technology
Healthcare leaders recognize patients as their most important area of focus. At the same time, however, overseeing business needs like inventory management, reimbursement, price transparency and staff shortages are top priorities. Significant opportunities exist for orthopedic clinics and ASCs to leverage automation to address these issues – but choosing the right solution can be daunting.
For more information, please click here to read the entire Becker’s article
Knee Orthoses Documentation of Knee Instability Reminder
CGS wants to remind suppliers and providers that knee orthosis coverage for codes L1832, L1833, L1843, L1844, L1845, L1846, L1851, and L1852 requires 1 of 2 pathways to meet coverage criteria:
Recent injury or surgical procedure or ambulatory with knee instability:
- The treating practitioner is responsible for understanding the appropriate treatment/testing necessary based on the beneficiary’s clinical presentation.
- Medical records must include documentation of the examination of the beneficiary and an objective description of joint laxity.
- Includes testing of the beneficiary (such as varus/valgus instability, anterior/posterior Drawer test, not all inclusive)
- The objective test needs to show that the test resulted in an instability of the knee
- Note: The instability of the knee joint is a result of insufficiencies in the ligaments of the knee complex. A result of instability is a separate finding from other deficits found on exam, such as a malalignment or meniscus conditions. A subjective statement of instability or an X-Ray report would not be sufficient documentation to support the findings of knee instability.
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