CMS Updates Face-to-Face, Prior Authorization Lists

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) released updates to the Required Face-to-Face and Written Order Prior to Delivery List, Required Prior Authorization List and Master List. 

According to a newsletter from the American Association for Homecare (AAHomecare), there are a total of three lists that suppliers should be aware of:

• Required Face-to-Face Encounter and Written Order Prior to Delivery (F2F/WOPD) List
• Required Prior Authorization List
• Master List of Items Potentially Subject to Face-to-Face Encounter, Written Order Prior to Delivery and Prior Authorization (Master List)
   

Beginning Wednesday, Oct. 28, items added to the Required F2F/WOPD List and Required Prior Authorization List will need to begin meeting the new requirements.

CMS added the following items to the Required F2F/WOPD List:

• Mobility: E1161, K0002, K0003, K0004, K0005, K0006, K0007, K0831
• Respiratory: E0466, E0467, E0468
• Orthosis: L0486, L0456, L0457, L1833, L1906, L1933, L1952, L3761, L3916
• Pressure reducing support surfaces: E0194
   

Beginning on Wednesday, Oct. 28, these items will be required to have a documented face-to-face encounter within six months prior to the written order.

The following items were added to the Required Prior Authorization List:

• Mobility: K0005 
• Orthoses: L1833, L0456, L0457, L0486, L3761, L3916
• Pressure reducing support surfaces: E0194
   

Beginning on Wednesday, Oct. 28, prior authorization will be implemented nationwide for the items listed. CMS will publish sub-regulatory guidance regarding the implementation of the items to the program.

Items eligible to be added to the Master List:

• Continuous glucose monitor supplies: A4239
• Mobility: E2298, K0831
• Orthoses: L0456, L0486, L1833, L1933, L1952, L3916
• Prostheses: L5827 
• Surgical dressings: A6022, A6197
• Pneumatic compression: E0658, E0659
• Non-pneumatic compression: E0683
• Rehabilitative therapy devices: E0738, E0739
• External electrical stimulation devices: E0734, A4594
• Urinary suction pumps: E2001
   

AAHomecare said these changes are in addition to the updates CMS made to the lists earlier this year. The organization continued there is no immediate direct impact to suppliers for items being added to the Master List; inclusion simply means the items are eligible to be added to the F2F/WOPD Required List and Prior Authorization Required List in the future.