Medicare Program; Updates to the Master List of Items Potentially Subject to Face-to-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements; Updates to the Required Face-to-Face Encounter and Written Order Prior to Delivery List; and Updates to the Required Prior Authorization List
What happened
The Centers for Medicare & Medicaid Services (CMS) updated the Master List, Required Face-to-Face Encounter and Written Order Prior to Delivery List, and Required Prior Authorization List, as announced on July 30, 2026. These updates, excluding upper limb orthoses, are effective October 28, 2026. Prior authorization for upper limb orthoses will be phased in, starting October 28, 2026, for New York, Michigan, Florida, and California, and expanding to all states by April 26, 2027.
Why it matters
These updates define which medical items may require extra steps like doctor visits or prior approval for Medicare beneficiaries. This impacts how and when patients can receive specific durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). The changes intend to address potential vulnerabilities to the Trust Fund.
Who it affects
- ›Medicare beneficiaries
- ›Healthcare providers (doctors, suppliers)
- ›Hospitals and medical facilities
- ›Manufacturers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
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