Medicare Refreshes Prior Auth List for Doctor Visits
Published Date: 7/30/2026
Rule
Summary
This document announces updates to the Healthcare Common Procedure Coding System (HCPCS) codes on the Master List. It also announces updates to the HCPCS codes on the Required Face-to-Face Encounter and Written Order Prior to Delivery List and the Required Prior Authorization List.
Analyzed Economic Effects
3 provisions identified: 0 benefits, 2 costs, 1 mixed.
New Face-to-Face Encounter Requirement
CMS is adding 22 HCPCS codes to the Required Face-to-Face Encounter and Written Order Prior to Delivery List effective October 28, 2026. For these items (for example, certain wheelchairs, orthoses, home ventilators, oxygen systems, and an air-fluidized bed), the treating practitioner must have a face-to-face encounter with the beneficiary within the 6 months before the written order, and that encounter must be documented in the medical record. Telehealth may be used where appropriate.
New Prior Authorization Requirements for Selected DME
CMS added 8 HCPCS codes to the Required Prior Authorization List; these will require a prior authorization request (including written order, medical record evidence, and supplier documentation) before the item is provided and the claim submitted. Implementation (excluding upper limb orthoses) is effective October 28, 2026; prior authorization for two upper limb orthoses (L3761, L3916) will be phased: Phase 1 (NY, MI, FL, CA) on October 28, 2026; Phase 2 (adds PA, MA, OH, IL, TX, GA, AZ, OR) on January 26, 2027; Phase 3 (all other states/territories) on April 26, 2027.
More DMEPOS Items Added to Master List
CMS added 20 HCPCS codes to the Master List on October 28, 2026, and updated the CY2026 payment thresholds so the adjusted purchase threshold is $614 and the adjusted monthly rental threshold is $62. Of the 20 additions, 8 codes (including A4239, A6022, A6197, K0831, L0456, L0486, L1833, L3916) were added for aberrant billing patterns (at least 1,000 claims and $1 million in payments with >30% payment increase).
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