Starting October 15, 2026, CMS will require probationary prior authorization for certain DMEPOS items billed by newly enrolled suppliers and suppliers undergoing certain changes of ownership.
This program is authorized under Section 1866(j)(3) of the Social Security Act and 42 CFR §424.527, which establishes a one-year probationary period for newly enrolled and ownership-changing DMEPOS suppliers. This probationary period begins when a supplier submits their first bill for one of the DMEPOS items on the Probationary Prior Authorization List (PDF).
Prior authorization allows suppliers to ensure that a DMEPOS item meets applicable Medicare coverage, payment, and coding rules before items are delivered. This advance review helps to protect the Medicare Trust Fund from improper payments while ensuring that beneficiaries can receive the DMEPOS items they need in a timely manner.