CMS expands prior authorization program

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Monday, June 4, 2018

WASHINGTON – CMS will roll the standard power mobility device codes that are currently part of a PMD Prior Authorization Demonstration in 19 states into the National Prior Authorization Program on Sept. 1, the agency announced late on Friday.

The PMD PA Demo was due to expire Aug. 31. Industry stakeholders have been lobbying CMS to expand the prior authorization requirement for PMDs to all states and to also apply it to complex rehab wheelchairs.

Currently, there are only two codes in the National PA Program: complex rehab codes K0856 and K0861.

“AAHomecare has been working with CMS to get the Demonstration implemented nationally and is pleased to see this announcement,” the association announced in a bulletin this morning.

Stakeholders expect CMS to publish sub-regulatory guidance on the transition at a later date.

The PMD PA Demo kicked off in September 2012 in seven states and was expanded to an additional 12 states in 2014.