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Condition of Payment Prior Authorization (PA) Program for HCPCs Codes K0856 and K0861 Has Been Expanded Nationally

Read this important message to learn what this means to you!

Effective July 3, 2017, all Durable Medical Equipment Medicare Administrative Contractors (DME MACs) began accepting Prior Authorization Requests (PAR) for the K0856 – Group 3 standard, single power option and K0861 – Group 3 standard multiple power option wheelchairs for dates-of-delivery on or after July 17, 2017 for beneficiaries residing in all US STATES and TERRITORIES.

Effective July 17, 2017 Request for ADVANCE DETERMINATION OF MEDICARE COVERAGE (ADMC) will no longer be accepted for the above mentioned HCPCS codes.

Medicare beneficiaries residing in New York (Jurisdiction A – Noridian), Illinois (Jurisdiction B – CGS), West Virginia (Jurisdiction C – CGS) and, Missouri (Jurisdiction D – Noridian) the effective dates for delivery are on or after March 20, 2017.

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Education Opportunities

Understanding Auditing Entities Webinar November 29
Still not quite sure about all the different contractors and exactly what they do? This webinar outlines the purpose behind each auditing entity, whether they audit pre- or post-pay claims, and tips on how to respond to audits. RegisterExternal website today to save your spot!.

Oxygen: Ask the Contractor Teleconference (ACT) December 13
The Provider Outreach and Education team has scheduled an ACT call on December 13 to discuss oxygen and related supplies. The teleconference will begin at 10:30 AM EST (9:30 AM CST). We will begin the call with an overview of coverage criteria, then open the lines for you to ask your Medicare-related questions on this topic. For more information, please visit our website.

Have you checked out our Physician’s Corner?
We know that sometimes it can be challenging to get the important physician-based information you need in order to provide durable medical equipment to Medicare beneficiaries. That’s why CGS has created the Physician’s Corner on our website, where you can find a number of great resources including the popular Dear Physician Letters, Medicare Minute MD videos and Physicians! Are You Ordering...” articles. Provided by Dr. Robert Hoover, the Jurisdiction C Medical Director, these resources provide detailed information and resources you can pass along to the practitioners you work with to explain the documentation requirements for DMEPOS items. Check it out today!

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