Reminder: Prior Authorization Effective Nationally for Five Orthotics HCPCS Codes
Orthotics & Prosthetics
on October 13, 2022
By Ronda Buhrmester, Sr. Director of Payer Relations and Reimbursement, VGM & Associates
The five orthotic HCPCS codes that are under the required prior authorization list are effective nationally as of October 10, 2022. The PA process for these codes was a phased-in approach. Phase 1 started in April with one state in each jurisdiction. In July, Phase 2 included a few more states within each of the four jurisdictions. October 10 is Phase 3 and the final phase where it’s required in all states, nationally. For traditional Medicare FFS, a PA is required prior to delivery for L0648, L0650, L1832. L1833, L1851. The PA is required when the product is being submitted for payment under the DME benefit to the DME MAC contractor. A CMS prior authorization is not accepted post-delivery.
The coverage criteria outlined in the medical policy (LCD) must still be met and submitted with the prior authorization. In addition to the PA, the same HCPCS codes require a face-to-face (F2F) and WOPD that must be written within 6 months of the F2F visit.
Click here for the recording of a webinar on this topic from August 2022. Stay tuned for future webinars about this topic!
- billing & reimbursement
- orthotics & prosthetics
- orthotics and prosthetics