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.
Your PRIA Score
Personalized for You
How does this regulation affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this federal register document and every other regulation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Key Dates
Department and Agencies
Related Federal Register Documents
2026-10292 — Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments
This proposed rule changes how states can pay Medicaid managed care plans and certain doctors to make sure payments are fair, efficient, and encourage enough providers to offer quality care. It affects states, Medicaid managed care organizations, and targeted Medicaid practitioners, aiming to keep payments balanced and services available. Comments on these changes are open until July 21, 2026, so stakeholders have time to weigh in before it’s finalized.
2026-10050 — Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program
Starting in 2027, health insurance plans on federal and state marketplaces will see new rules to make coverage fairer and easier to use. These changes affect insurance companies, agents, and people buying plans, including new fees, penalties, and better protections for those with hardships. Expect updates on plan quality, dental coverage limits, and longer-term catastrophic plans, all aiming to keep your health coverage solid and affordable.
2026-07205 — Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges
This new rule will help Medicare, Medicaid, CHIP, and health plan companies share patient info more easily and speed up drug approval requests. It affects Medicare Advantage, Medicaid, CHIP, and health plans on federal exchanges, aiming to make care smoother and faster. These changes will start soon and could save time and money by cutting red tape.
2026-04797 — Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program; Correction
This document fixes some typos and technical mistakes in the Medicare and Medicaid payment rules for 2026. It affects doctors, healthcare providers, and anyone using Medicare Part B by clarifying payment policies and program requirements starting January 1, 2026. These corrections help make sure payments and coverage rules are clear and accurate, so everyone gets paid right and on time.
2026-04467 — Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program; Correction
This correction fixes some missing labels in important tables from the 2027 health insurance rules under the Affordable Care Act. It mainly affects insurance companies and people using marketplace plans by clarifying how risk and payments are calculated. These fixes take effect right away on March 6, 2026, ensuring everyone has clear info before the 2027 plan year starts.
2025-23081 — Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2026 and Updates to the IRF Quality Reporting Program; Correction
This correction fixes some math and typo mistakes in the Medicare payment rules for inpatient rehab facilities starting October 1, 2025. It mainly affects rehab centers by updating their payment rates and quality reporting details to be fair and accurate. These changes ensure providers get the right money and info for the 2026 fiscal year.
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.