Medicare Demands Face Time for Your Wheelchair Order
Published Date: 1/13/2026
Rule
Summary
Starting April 13, 2026, Medicare is updating the list of medical items that need a face-to-face doctor visit, a written order, or prior approval before you get them. These changes affect patients, doctors, and suppliers by making sure the right checks happen before certain equipment or services are provided. This helps keep care safe and costs clear for everyone involved.
Analyzed Economic Effects
4 provisions identified: 1 benefits, 1 costs, 2 mixed.
Oxygen Equipment Requires Face-to-Face Visit
Effective April 13, 2026, CMS adds eight oxygen-related HCPCS codes to the Required Face-to-Face Encounter and Written Order Prior to Delivery List. For these oxygen supplies and devices, the treating practitioner must have a face-to-face encounter with the beneficiary within the 6 months before the written order; telehealth may be used when appropriate under existing rules.
Seven Items Added to Prior Authorization List
Beginning April 13, 2026, CMS adds seven HCPCS codes to the Required Prior Authorization List: five orthoses codes and two pneumatic compression device codes. Before providing these items and submitting a claim, a requester must submit a prior authorization request with the written order and relevant medical record; CMS or its contractors will provisionally affirm or non-affirm the request after review.
18 HCPCS Codes Added to Master List
On April 13, 2026, CMS adds 18 HCPCS codes to the Master List of DMEPOS items that may be subject to face-to-face encounter, written order prior to delivery, and/or prior authorization. The added codes include items such as continuous glucose monitor supplies, wound dressings, certain orthoses, power wheelchair accessories, and miscellaneous DME (see Table 1 in the notice). These items may be selected from the Master List for additional payment conditions in the future.
CMS Estimates $32.1M Net Savings
CMS estimates the additions to the prior authorization program will result in an estimated net savings of $32.1 million. The gross savings assumption is based on a 20 percent reduction in paid claims for the relevant items, with review costs deducted to arrive at the net savings estimate.
Personalized for You
How does this regulation affect your finances?
Personalize government policy and PRIA will tell you what this federal register document means for your household, plus every other regulation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.
Key Dates
Department and Agencies
Related Federal Register Documents
2026-20281, Global Benchmark for Efficient Drug Pricing (GLOBE) Model
Starting November 30, 2026, Medicare will use the new GLOBE Model to help lower the cost of certain drugs for people on Original Medicare. This model changes how drug price increases are calculated, aiming to save money for both patients and the Medicare program without cutting care quality. If you’re on Medicare Part B, expect smarter drug pricing that helps keep your healthcare affordable.
2026-20131, Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2027 and Updates to the IRF Quality Reporting Program; Correction
This correction fixes some technical mistakes in the Medicare payment rules for inpatient rehab facilities starting October 1, 2026. It mainly affects hospitals and rehab centers by clarifying how wage data and payments are calculated, ensuring fairer payment rates for fiscal year 2027. No big changes in money, but it keeps everything accurate and on track.
2026-19959, Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2027; Correction
This correction fixes some technical mistakes in Medicare payment rules for skilled nursing facilities starting October 1, 2026. It mainly affects how hospital data is used to calculate payments, making sure no current hospitals are wrongly excluded. These tweaks help keep Medicare payments fair and accurate for providers and patients.
2026-20067, Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements; Correction
This correction fixes some technical mistakes in the FY 2027 hospice payment and wage index rules that were first published in August 2026. It mainly affects hospice providers by updating how their payments are calculated, making sure the numbers are accurate starting October 1, 2026. These changes help ensure hospices get the right payment amounts based on the latest hospital wage data.
2026-19946, Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year (FY) 2027 Rates; Requirements for Quality Programs; Other Policy Changes; and Adoption of Updated Versions of Certain Health Information Technology Standards; Correction
This update fixes some typos and technical mistakes in the Medicare payment rules for hospitals starting October 1, 2026. It affects hospitals getting paid for patient care, making sure the payment system and quality programs run smoothly. These corrections help hospitals get the right payments and follow updated health tech standards without delays or confusion.
2026-15686, Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
This final rule updates the hospice wage index, payment rates, and aggregate cap amount for fiscal year 2027. This final rule also includes an analysis of Medicare non-hospice spending, including details regarding a hospice service and spending variation index, and finalizes the requirement that hospices provide the hospice election statement addendum to all Medicare beneficiaries at the time of hospice election. Additionally, this rule finalizes conforming changes to discharge from hospice care regulations and changes to the face-to-face encounter regulations. This final rule also includes a summary of comments received on our requests for information regarding community- based palliative care; the construction of a hospice specific wage index; and the overlap between hospice and medical aid in dying laws. Finally, this rule finalizes changes to the Hospice Quality Reporting Program.
Previous / Next Documents
Previous: 2026-00482, Service of Process; Address Change
Starting January 13, 2026, the Department of State has a new address for receiving legal papers like summonses and complaints. This change affects anyone sending legal documents to the Department or its current and former employees. No extra costs or delays are expected, just a smoother, updated process after the Department’s 2025 reorganization.
Next: 2026-00535, Civil Monetary Penalties-2026 Adjustment
Starting January 14, 2026, the Surface Transportation Board is raising its civil fines to keep up with inflation. This means companies involved in rail, motor, water, and pipeline transportation might pay a bit more if they break the rules. The increase is based on recent price changes, making sure penalties stay fair and effective.