Medicare Adds Four DMEPOS Items to Master List

APMA members who prescribe or supply durable medical equipment (DME) to Medicare Part B beneficiaries should be aware of upcoming changes to Medicare's Master List of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items Potentially Subject to Conditions of Payment.

Medicare maintains both the Master List and a separate Required Prior Authorization List. Inclusion on the Master List does not mean an item requires prior authorization. Rather, items on the Master List have been identified by Medicare as potentially susceptible to fraud or unnecessary utilization and may be subject to additional conditions of payment. Of the 550 items currently on the Master List, only 82 are on the Required Prior Authorization List.

Effective October 28, Medicare will add four items to the Master List that may be relevant to podiatric physicians:

• HCPCS A6022: Collagen dressing, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each.

• HCPCS A6197: Alginate or other fiber-gelling wound dressing, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing.

• HCPCS L1933: Ankle-foot orthosis with rigid anterior tibial section, total carbon fiber or equivalent material, prefabricated, off-the-shelf.

• HCPCS L1952: Spiral ankle-foot orthosis (Institute of Rehabilitative Medicine type), plastic or other material, prefabricated, off-the-shelf.

What APMA Members Should Know

The addition of these codes to the Master List does not, by itself, create a prior authorization requirement. Members who prescribe or supply these items should nevertheless be aware of their inclusion on the list and continue to follow applicable Medicare coverage, documentation, and billing requirements.

Visit CMS for more information about the Master List of DMEPOS Items Potentially Subject to Conditions of Payment.