CMS Updates-Compliance Corner

CMS Updates to the Master List, Required Face to Face/Written Order Prior to Delivery List, and Required Prior Authorization List

ACU-Serve | January 15, 2026 |

Dear Supplier,

On January 13, 2026, CMS published in the Federal Register  an update to the Master List, required items for face to face, written order prior to delivery and prior authorization. Below is summary of the changes but the detailed report can be reviewed at Federal Register.

Please note the implementation of updates to the Master List, the Required Face-to-Face and Written Order Prior to Delivery List, and the Required Prior Authorization List are effective on April 13, 2026.

Summary covers the following:

  1. The Master List of Items Potentially Subject to Face‑to‑Face Encounter, Written Order Prior to Delivery, and/or Prior Authorization
  2. The Required Face‑to‑Face Encounter and Written Order Prior to Delivery (F2F/WOPD) List
  3. The Required Prior Authorization List

  1. Updates to the Master List
    Payment Threshold Adjustments
    • For CY 2025, CMS increased the payment thresholds based on inflation and productivity adjustments:
      • Purchase threshold: $602
      • Monthly rental threshold: $61

 

Additions to the Master List (See table on page 7)

    • 18 HCPCS codes have been added.
      • 8 codes meet updated payment thresholds and appear in OIG/GAO/CERT reports.
      • 10 codes were added due to aberrant billing patterns, each showing >30% payment increases without explanatory factors.

 

It is important to note the addition of these codes to the Master List does not automatically subject them to face to face, written order prior to delivery or prior authorization. This only means these codes can selected by CMS in the future for one or all of the program.

 

Below are the list of codes added to the Master List.

 

Removals

    • No HCPCS codes were removed in this update.

 

  1. Updates to the Required Face‑to‑Face Encounter and Written Order Prior to Delivery ListCMS added eight oxygen‑related HCPCS codes to the F2F/WOPD List due to:
    • High improper payment rates identified by the CERT program
    • Billing vulnerabilities and policy analysis
    • The need for increased practitioner oversight

 

Newly added codes include:

    • Stationary and portable oxygen systems (E0424, E0431, E0433, E0434, E0439)
    • Oxygen concentrators (E1390, E1391, E1392)

 

  1. Updates to the Required Prior Authorization ListCMS added seven HCPCS codes to the Required Prior Authorization List, effective nationwide (See page 10-11):
    • Orthoses (5 codes):
      • Lumbar‑sacral orthosis (L0651)
      • Custom and prefabricated knee orthoses (L1844, L1846, L1852)
      • Carbon fiber ankle‑foot orthosis (L1932)
    • Pneumatic Compression Devices (2 codes):
      • Non‑calibrated and calibrated segmental home models (E0651, E0652)
    • Rationale for additions:
      • Orthoses: Improper payment rates between 35–57% and documented fraud schemes
      • Pneumatic compression devices: Improper payment rates up to 78.9%, with rising medical‑necessity errors

 

****Prior authorization remains required for all previously listed items.

 

The CMS Calendar Year (CY) 2026 Home Health Prospective Payment System Final Rule (CMS-1828-F)  includes a provision permitting the temporary exclusion of DMEPOS suppliers from the mandatory prior authorization program, provided they maintain an approval rate of 90 percent or greater.

 

In the article published on January 13, 2026, by CGS, the Jurisdiction B and C DME MAC, Medicare further clarified the operational details of this exception:

  • DME Medicare Administrative Contractors (MACs) will evaluate suppliers’ prior authorization approval rates.
  • Suppliers achieving an approval rate of 90 percent or higher will be afforded the option, on an annual basis, to be exempt from submitting prior authorization requests for that year.
  • To determine continued eligibility for exemption, the DME MACs will conduct an annual post‑payment medical review of a sample of claims to verify compliance.
    • From this sample, suppliers must again achieve an approval rate of 90 percent or greater to retain their exemption status.
  • Suppliers who fail to meet the 90 percent threshold must continue to submit prior authorization requests as a condition of payment.
  • The DME MAC will provide suppliers with at least 60 days’ notice prior to the start of an exemption period or prior to the withdrawal of an exemption before its effective date.

 

During the public comment period, stakeholders advocated for suppliers’ ability to decline the exemption and continue participating in the prior authorization process even when meeting the 90 percent approval threshold. It appears CMS has adopted this position, thereby allowing suppliers to opt out of the exception. This option may help mitigate exposure to post‑payment audit scrutiny by the MACs or other contractors.

 

As is customary, it is anticipated that the DME MACs will initiate provider education activities in advance of the implementation date. Should you have any additional questions, comments, or concerns, please feel free to contact me.

 

Sincerely,

 

Noel Neil JM CDME
Chief Compliance Officer