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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  • The DME MAC will notify suppliers at least 60 days before an exemption starts or is withdrawn before the effective date.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!

Publication History
January 20, 2026 Revised to clarify information about exemption dates and opting out.
January 13, 2026 Originally Published

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