PA for Group 2 Pressure Reducing Support Surfaces and Additional PMD Required for Date of Service/Delivery on and after July 22 in Certain States
Prior authorization is required for Group 2 Pressure Reducing Support Surfaces (PRSS) (HCPCS E0193, E0277, E0371, E0372, and E0373) for California, Indiana, New Jersey, and North Carolina with dates of service on and after July 22, 2019.
Phase II DME MACs will begin accepting prior authorization requests for the above Group 2 codes on October 07, 2019 for all remaining states/territories, for dates of delivery on or after October 21, 2019. All new rental series claims nationwide, for E0193, E0277, E0371, E0372, and E0373 with a DOS on or after October 21, 2019, must have a prior authorization request on file.
Prior authorization is also required for the additional Power Mobility Device HCPCS Codes: K0857, K0858, K0859, K0860, K0862, K0863, and K0864 nationwide for dates of service on or after July 22, 2019. ADMC will no longer be available for these codes effective July 08, 2019
Additional information is located on the Prior Authorization pages at: https://www.cgsmedicare.com/jb/mr/condition_of_payment_prior_auth.html