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04/24/2017

CMS Special Open Door Forum on April 25

Coverage and Documentation Requirements for Codes Subject to DMEPOS Prior Authorization-K0856 and K0861

 

CPI will host the third in a series of Special Open Door Forums (ODF) on Tues., April 25, 2-3 p.m. Eastern, for suppliers, physicians, and other Medicare practitioners or interested parties to discuss the coverage and documentation requirements for K0856 and K0861. These are the first two codes selected as part of the prior authorization process for Certain Items of Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS). 

As announced in the Federal Register Notice 6072, as published on December 21, 2016, CMS has selected two DMEPOS items, represented by HCPCS (Healthcare Common Procedure Coding System) codes K0856 and K0861. These power wheelchairs, when furnished on or after March 20, 2017, require prior authorization as a condition of payment for beneficiaries in the states of IL, MO, NY, and WV.

This announcement follows CMS’ final rule establishing a prior authorization process for certain DMEPOS items that are frequently subject to unnecessary utilization. The rule, as published in late December 2015, provided a Master List of 135 DMEPOS items frequently subject to unnecessary utilization and the criteria for their inclusion on the Master List, subject to annual updates. The rule specified that presence on the Master List does not automatically create a prior authorization requirement for that item. Rather, CMS selects items from the Master List to be subject to prior authorization as a condition for payment. The selected items are included on what is known as the Required Prior Authorization List, and must be publically announced through Federal Register Notice. K0856 and K0861 are the first two items added to the Required Prior Authorization List.

The Chief Medical Officer for CGS, Jurisdiction C DME Medicare Administrative Contractor (MAC), will present on the coverage and documentation requirements for K0856 and K0861. Participants will have the opportunity to ask questions on the call.

CMS is committed to launching the DMEPOS Prior Authorization Program in an open and transparent manner that serves and protects patients and the health care providers that care for them.  CMS has the opportunity to learn from patient and provider experience and welcomes feedback as a critical part of this process.  We look forward to an ongoing dialogue to help us gather feedback and learn how the program can best meet patients’ needs. 

Here is the link to our Prior Authorization Initiatives page where slides will be posted, as well as frequently asked questions, a fact sheet, and an operational guide in the downloads section: 

https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/DMEPOS/Prior-Authorization-Process-for-Certain-Durable-Medical-Equipment-Prosthetic-Orthotics-Supplies-Items.html

You can find the final rule by going to: https://www.gpo.gov/fdsys/pkg/FR-2015-12-30/pdf/2015-32506.pdf.

You can find the federal register notice announcing the first two items subject to prior authorization under this process, here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-30273.pdf.

We look forward to your participation.

Special Open Door Participation Instructions:

Participant Dial-In Number: 1-800-837-1935

Conference ID #: 4591992

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

A transcript and audio recording of this Special ODF will be posted to the Special Open Door Forum website at http://www.cms.gov/OpenDoorForums/05_ODF_SpecialODF.asp for downloading      

For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.gov/opendoorforums/ .

Thank you for your interest in CMS Open Door Forums.