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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.

Related Information:

Education Opportunities

Jurisdiction B Medicare Updates ACT Call September 27
The Jurisdiction B Provider Outreach and Education staff will present an Ask the Contractor Teleconference on September 27, starting at 1:00 pm EST. This particular ACT call will focus on recent changes in the Medicare program from a CMS and a CGS perspective. Register now!

2017 MAMES Fall Excellence in HME October 4
Terri Shoup, Provider Relations Senior Analyst for Jurisdiction B, will represent CGS at the Midwest Association for Medical Equipment Services meeting at the Treasure Island Resort in Welch, MN. She will review recent changes in Medicare from a CGS and a CMS perspective. The entire MAMES meeting begins October 4 and concludes October 6. Visit Website for registration and the full schedule.

New Medicare Card Project Webinar October 19
Find out everything you need to know about the new Medicare Beneficiary Identifier MBI that will replace the SSN-based Health Insurance Claim Number HICN on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status. The latest information on timelines, transition period, and resources will be provided at 10:30 am EST. Be sure to registerExternal Website today for this valuable update.

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