Exemption Process for Prior Authorization of Certain DMEPOS Items
Certain DMEPOS suppliers will be offered exemption from prior authorization per CMS.
How it will work:
- DME Medicare Administrative Contractors (MACs) will review approval ratings of suppliers' prior authorization claims.
- After submitting at least 10 requests, if the supplier's approval rating is 90% or higher, they will have the option to be exempt for the year from submitting prior authorization requests.
- Suppliers who do not meet the 90% compliance rate threshold must continue submitting prior authorization requests as a condition of payment.
- The DME MAC will notify suppliers at least 60 days before an exemption starts or is withdrawn before the effective date.
- Suppliers will get written notice of their exemption status no later than April 2, 2026. The first exemption cycle will begin on June 1, 2026, and will occur annually.
- Suppliers can choose to opt out of exemption and continue submitting prior authorization requests.
Stay tuned for more details!
| January 20, 2026 | Revised to clarify information about exemption dates and opting out. |
| January 13, 2026 | Originally Published |

