CMS Updates Medicare Prior Authorization and Encounter Lists
The Centers for Medicare & Medicaid Services is updating HCPCS codes for items requiring prior authorization and face-to-face encounters [1].
The Centers for Medicare & Medicaid Services (CMS) is updating the Healthcare Common Procedure Coding System (HCPCS) codes across three primary registries: the Master List, the Required Prior Authorization List, and the Required Face-to-Face Encounter and Written Order Prior to Delivery List.
These lists identify durable medical equipment, prosthetics, orthotics, and supplies that CMS considers vulnerabilities to the Trust Fund. The Master List serves as the library from which items are selected for the more restrictive prior authorization and face-to-face encounter requirements.
Most updates to these lists take effect October 28, 2026.
Prior authorization for upper limb orthoses will follow a staggered three-phase rollout. Phase one begins October 28, 2026, in California, Florida, Michigan, and New York. Phase two expands to include Arizona, Georgia, Illinois, Massachusetts, Ohio, Pennsylvania, and Texas on January 26, 2027.
All remaining states and territories will enter phase three on April 26, 2027.
Source: Federal Register