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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 HCPC’s 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

Cleveland Comprehensive Workshop August 16
Dr. Stacey Brennan, Jurisdiction B DME MAC Medical Director, will be joining the CGS Provider Outreach and Education team for a comprehensive workshop on August 16 at the DoubleTree Downtown. Dr. Brennan will discuss recent changes in the Medicare program, while our POE representatives cover documentation requirements, ABNs, upgrades, modifiers and competitive bid. Workshop cost of $75 covers all educational materials for the day. It’s a great opportunity to get your questions answered live and in person, so reserve your space now because space is limited!

Alsip, IL DME Comprehensive Workshop September 20
Registration is now open for the CGS Comprehensive Workshop being held at the DoubleTree by Hilton Chicago-Alsip. Dr. Stacey Brennan, the Jurisdiction B DME MAC Medical Director, will discuss the most recent changes and updates in the Medicare program from both CMS and CGS as well as detail recent policy changes. Along with presentations on DME Documentation Requirements, ABNs and Upgrades, and Modifiers, the Competitive Bidding Implementation Contractor (CBIC) will be on hand to provide status updates on Round 2019, Round 2 recompete/national mail-order recompete, and Round 1, 2017. Deadline for registration is Thursday, September 14.


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