The Centers for Medicare & Medicaid Services has issued updates for several durable medical equipment codes effective in late October.
According to the information published in the July 30 edition of the Federal Register, prior authorization requirements for the upper limb orthoses will be implemented in three phases: phase one includes New York, Michigan, Florida and California and is effective Oct. 28. Phase two includes the states in phase one and Pennsylvania, Massachusetts, Ohio, Illinois, Texas, Georgia, Arizona and Oregon and is effective Jan. 26, 2027. Phase three includes all states and territories not included in phases one and two and is effective April 26, 2027.
The codes are:
- E0194 (air fluidized bed)
- K0005 (ultralightweight manual wheelchairs)
- L1833 (knee orthosis, adjustable knee joints)
- L0456 (thoracic-lumbar-sacral orthosis, flexible, prefabricated item customized to fit a specific patient)
- L0457 (thoracic-lumbar-sacral orthosis, flexible, prefabricated, off the shelf)
- L0486 (thoracic-lumbar-sacral orthosis, triplanar control, includes carved plaster or CAD-CAM model, custom fabricated)
- L3761 (elbow orthosis)
- L3916 (wrist hand orthosis)