CMS adjusts requirements for replacements
By HME News Staff
Updated 9:47 AM CDT, Thu July 18, 2024
WASHINGTON – CMS will require prior authorization for all power mobility devices being replaced within the five-year useful lifetime effective June 2, NCART reports. Providers should submit prior authorizations as an expedited request and the agency will process them within two business days. For wheelchairs being replaced due to loss, theft or irreparable damage, the following should be included with the request: information and/or detailed reports that explain the reason leading to the need for replacement, such as policy report when the PMD is lost or stolen; and a physician’s written order prior to delivery (WOPD) for the new replacement items. If CMS affirmed the original prior authorization, the DME MACs will not review for medical necessity. Once the request is affirmed, providers should submit the claim with the RA modifier. For wheelchairs being replaced due to change in medical need or reasonable useful lifetime met, the following should be included with the request: a new face-to-face evaluation, WOPD and documentation from the medical record that supports the need for the item and documentation to support the change in condition, if applicable.
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