By Donna Youngblood, RN, Clinical Consultant at The van Halem Group
CMS released its long awaited Master List on January 12, 2022 with new codes being added to both the Master list and Required List. In addition, they have added Power Operated Vehicles (POV) to the list of HCPCS requiring prior authorization.
Starting April 13, 2022, CMS will remove the following codes from the Master List:
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CMS will be adding the following codes to the Master List:
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Additions to the Master List |
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HCPCS |
Description |
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A4352 |
Intermittent Urinary Catheter; Coude (Curved) Tip, With Or Without Coating (Teflon, Silicone, Silicone Elastomeric, Or Hydrophilic, Etc.), Each |
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A5121 |
Skin Barrier; Solid, 6 X 6 Or Equivalent, Each |
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A6203 |
Composite Dressing, Sterile, Pad Size 16 Sq. In. Or Less, With Any Size Adhesive Border, Each Dressing |
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A6219 |
Gauze, Non-Impregnated, Sterile, Pad Size 16 Sq. In. Or Less, With Any Size Adhesive Border, Each Dressing |
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A6242 |
Hydrogel Dressing, Wound Cover, Sterile, Pad Size 16 Sq. In. Or Less, Without Adhesive Border, Each Dressing |
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A7030 |
Full Face Mask Used With Positive Airway Pressure Device, Each |
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A7031 |
Face Mask Interface, Replacement For Full Face Mask, Each |
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E0467 |
Home Ventilator, Multi-Function Respiratory Device, Also Performs Any Or All Of The Additional Functions Of Oxygen Concentration, Drug Nebulization, Aspiration, And Cough Stimulation, Includes All Accessories, Components And Supplies For All Functions |
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E0565 |
Compressor, Air Power Source For Equipment Which Is Not Self-Contained Or Cylinder Driven |
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E0650 |
Pneumatic Compressor, Non-Segmental Home Model |
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E0651 |
Pneumatic Compressor, Segmental Home Model Without Calibrated Gradient Pressure |
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E0652 |
Pneumatic Compressor, Segmental Home Model With Calibrated Gradient Pressure |
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E0656 |
Segmental Pneumatic Appliance For Use With Pneumatic Compressor, Trunk |
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E0657 |
Segmental Pneumatic Appliance For Use With Pneumatic Compressor, Chest |
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E0670 |
Segmental Pneumatic Appliance For Use With Pneumatic Compressor, Integrated, 2 Full Legs And Trunk |
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E0675 |
Pneumatic Compression Device, High Pressure, Rapid Inflation/Deflation Cycle, For Arterial Insufficiency (Unilateral Or Bilateral System) |
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E0740 |
Non-Implanted Pelvic Floor Electrical Stimulator, Complete System |
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E0744 |
Neuromuscular Stimulator For Scoliosis |
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E0745 |
Neuromuscular Stimulator, Electronic Shock Unit |
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E0764 |
Functional Neuromuscular Stimulation, Transcutaneous Stimulation Of Sequential Muscle Groups Of Ambulation With Computer Control, Used For Walking By Spinal Cord Injured, Entire System, After Completion Of Training Program |
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E0766 |
Electrical Stimulation Device Used For Cancer Treatment, Includes All Accessories, Any Type |
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E1226 |
Wheelchair Accessory, Manual Fully Reclining Back, (Recline Greater Than 80 Degrees), Each |
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E2202 |
Manual Wheelchair Accessory, Nonstandard Seat Frame Width, 24-27 Inches |
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E2203 |
Manual Wheelchair Accessory, Nonstandard Seat Frame Depth, 20 To Less Than 22 Inches |
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E2613 |
Positioning Wheelchair Back Cushion, Posterior, Width Less Than 22 Inches, Any Height, Including Any Type Mounting Hardware |
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L0830 |
Halo Procedure, Cervical Halo Incorporated Into Milwaukee Type Orthosis |
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L1005 |
Tension Based Scoliosis Orthosis And Accessory Pads, Includes Fitting And Adjustment |
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L1906 |
Ankle Foot Orthosis, Multiligamentous Ankle Support, Prefabricated, Off-The-Shelf |
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L2580 |
Addition To Lower Extremity, Pelvic Control, Pelvic Sling |
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L2624 |
Addition To Lower Extremity, Pelvic Control, Hip Joint, Adjustable Flexion, Extension, Abduction Control, Each |
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L7368 |
Lithium Ion Battery Charger, Replacement Only |
CMS will be adding 11 items to the Prior Authorization program:
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ADDITIONS TO REQUIRED PRIOR AUTHORIZATION LIST |
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HCPCS |
Description |
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K0800 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
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K0801 |
Power Operated Vehicle, Group 1 Heavy Duty, Patient Weight Capacity, 301 To 450 Pounds |
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K0802 |
Power Operated Vehicle, Group 1 Very Heavy Duty, Patient Weight Capacity 451 To 600 Pounds |
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K0806 |
Power Operated Vehicle, Group 2 Standard, Patient Weight Capacity Up To And Including 300 Pounds |
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K0807 |
Power Operated Vehicle, Group 2 Heavy Duty, Patient Weight Capacity 301 To 450 Pounds |
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K0808 |
Power Operated Vehicle, Group 2 Very Heavy Duty, Patient Weight Capacity 451 To 600 Pounds |
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L0648 |
Lumbar-Sacral Orthosis, Sagittal Control, With Rigid Anterior And Posterior Panels, Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra, Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs, Includes Straps, Closures, May Include Padding, Shoulder Straps, Pendulous Abdomen Design, Prefabricated, Off-The- Shelf |
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L0650 |
Lumbar-Sacral Orthosis, Sagittal-Coronal Control, With Rigid Anterior And Posterior Frame/Panel(S), Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra, Lateral Strength Provided By Rigid Lateral Frame/Panel(S), Produces Intracavitary Pressure To Reduce Load On Intervertebral Discs, Includes Straps, Closures, May Include Padding, Shoulder Straps, Pendulous Abdomen Design, Prefabricated, Off-The-Shelf |
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L1832 |
Knee Orthosis, Adjustable Knee Joints (Unicentric Or Polycentric), Positional Orthosis, Rigid Support, Prefabricated Item That Has Been Trimmed, Bent, Molded, Assembled, Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise |
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L1833 |
Knee Orthosis, Adjustable Knee Joints (Unicentric Or Polycentric), Positional Orthosis, Rigid Support, Prefabricated, Off-The Shelf |
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L1851 |
Knee Orthosis (Ko), Single Upright, Thigh And Calf, With Adjustable Flexion And Extension Joint (Unicentric Or Polycentric), Medial-Lateral And Rotation Control, With Or Without Varus/Valgus Adjustment, Prefabricated, Off-The- Shelf |
Implementation of the six power operated vehicles will be implemented nationwide beginning April 13, 2022.
CMS will phase-in the five orthosis codes in 3 stages:
- Phase 1 (April 13, 2022): Implement only in California, Florida, Illinois, and New York
- Phase 2 (July 12, 2022): Implement only in Arizona, Georgia, Kentucky, Maryland, Michigan, Missouri, New Jersey, North Carolina, Ohio, Pennsylvania, Texas, and Washington
- Phase 3 (October 10, 2022): Nation-wide implementation
Lastly, CMS published the Face-to-Face (F2F) and Written Order Prior to Delivery (WOPD) Required List which includes all 46 Power Mobility Device (PMD) HCPCS codes since these are statutorily required, six orthosis codes, and one osteogenesis stimulator code.
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New Non-Statutorily Required F2F and WOPD Items |
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HCPCS |
Description |
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E0748 |
Osteogenesis Stimulator, Electrical, Non-Invasive, Spinal Applications |
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L0648 |
Lumbar-Sacral Orthosis, Sagittal Control, With Rigid Anterior And Posterior Panels, Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra, Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs, Includes Straps, Closures, May Include Padding, Shoulder Straps, Pendulous Abdomen Design, Prefabricated, Off-The-Shelf |
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L0650 |
Lumbar-Sacral Orthosis, Sagittal-Coronal Control, With Rigid Anterior And Posterior Frame/Panel(S), Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra, Lateral Strength Provided By Rigid Lateral Frame/Panel(S), Produces Intracavitary Pressure To Reduce Load On Intervertebral Discs, Includes Straps, Closures, May Include Padding, Shoulder Straps, Pendulous Abdomen Design, Prefabricated, Off-The-Shelf |
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L1832 |
Knee Orthosis, Adjustable Knee Joints (Unicentric Or Polycentric), Positional Orthosis, Rigid Support, Prefabricated Item That Has Been Trimmed, Bent, Molded, Assembled, Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise |
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L1833 |
Knee Orthosis, Adjustable Knee Joints (Unicentric Or Polycentric), Positional Orthosis, Rigid Support, Prefabricated, Off-The Shelf |
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L1851 |
Knee Orthosis (KO), Single Upright, Thigh And Calf, With Adjustable Flexion And Extension Joint (Unicentric Or Polycentric), Medial-Lateral And Rotation Control, With Or Without Varus/Valgus Adjustment, Prefabricated, Off-The-Shelf |
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L3960 |
Shoulder Elbow Wrist Hand Orthosis, Abduction Positioning, Airplane Design, Prefabricated, Includes Fitting And Adjustment |
DME Documentation Orthotics Respiratory Ventilators Wheelchairs
Posted: February 1, 2022 by van Halem Group
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