Voluntary Prior Authorization (PA) for DMEPOS Accessories

3.10.1.1- Voluntary Prior Authorization (PA) for DMEPOS Accessories (Rev: 12056; Issued: 05-25-23; Effective: 06-26-23; Implementation: 06-26-23) The 2019 ESRD and DMEPOS final rule (84 Fed. Reg. 60648 (Nov. 8, 2019)) permits CMS to develop a program to allow suppliers to voluntarily include certain accessories on prior authorization requests submitted for items on the Required Prior Authorization List. These accessories may receive a prior authorization decision for operational simplicity, even if the accessory itself is not on the Required Prior Authorization List. Voluntarily submitting a prior authorization request for accessories does not create a condition of payment and is not mandatory. Prior authorization requests for accessories must include a corresponding item on the Required Prior Authorization List; otherwise, the prior authorization request for the accessory will be rejected. Accessories submitted on a prior authorization request where the corresponding item on the Required Prior Authorization List is non-affirmed will also be non-affirmed. The list of DME items that require prior authorization can be found on Required Prior Authorization List, and the list of selected accessories that can be voluntarily added to prior authorization requests can be found on the Voluntary Prior Authorization List. The Required Prior Authorization List and the Voluntary Prior Authorization List will be updated as additional codes are selected. For more information, please see the CMS DMEPOS Prior Authorization website.