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.
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Key Dates
Department and Agencies
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