Medicare Program: Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (CMS-10524)

Section §414.234 of Social Security Act requires prior authorization as a condition of payment for certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). A claim with a provisional affirmative prior authorization decision will be paid as long as all other requirements are met. A claim with a non-affirmative decision or without a decision and submitted for processing will be denied.

The latest form for Medicare Program: Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (CMS-10524) expires 2022-03-31 and can be found here.