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CMS Implements Prior Authorization for New DMEPOS Suppliers

Published in VGM Government Relations on September 10, 2026

On Sept. 2, 2026, CMS introduced the Probationary Prior Authorization (PPA) program that will place newly enrolled DMEPOS Suppliers and those undergoing 100% change in ownership on a one-year probationary period. Effective Oct. 15, impacted suppliers will be required to submit a prior authorization request for specific HCPCS codes.  

HCPCS codes that will require prior authorization include:

  • Osteogenesis stimulators: E0747, E0748
  • Ankle-foot/knee-ankle-foot orthoses: L1902, L1906, L1971, L2035, L2132, L2134, L2136, L4360, L4361, L4396, L4397
  • Knee orthoses: L1810, L1812, L1820, L1821
  • Lower limb orthoses: L1652, L1653, L1686, L1690
  • Spinal orthoses: L0626, L0627, L0628, L0630, L0633, L0635, L0641, L0642, L0643, L0649, L0720
  • Upper limb orthoses: L3660, L3670, L3760, L3762, L3809, L3908, L3915, L3960

The CMS notice confirms that the Probationary Prior Authorization process does not replace the existing prior authorization process for certain DMEPOS items. Suppliers required to participate in the PPA program must continue to comply with existing prior authorization requirements for applicable DMEPOS items.

Access the announcement here for more information. 

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