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By Donna Youngblood RN, BSN, CPC

On April 3, 2020 CMS announced the suspension of Prior Authorization (PA) on certain Power Mobility Devices (PMDs) and Pressure Reducing Support Surfaces (PRSS) for the duration of the COVID-19 pandemic. Implementation of PA for Lower Limb Prosthetics (LLP) that was scheduled to begin on May 4, 2020 will now be delayed. Voluntary PA requests for the affected HCPCS codes on the required PA list My be submitted; however, all claims associated with these HCPCS will be processed for payment during the Public Health Emergency (PHE). CMS also indicated that “claims bypassing PA may be selected for post-payment review after the PHE has ended.”

Suppliers must continue to use appropriate modifiers for all of these HCPCS and are being instructed to use the CR modifier (CATASTROPHE/DISASTER RELATED) to the claim line for the HCPCS billed. Suppliers are also instructed the enter “COVID-19” in the notes on the appropriate claim form. These instructions also apply to all subsequent rental months’ claims for continued payment.

For claims denied due to the COVID-19 PHE that are associated with PA submissions on or after March 01, 2020 and prior to this notice, suppliers may request a reopening of their claim by contacting their MAC. CMS will provide further guidance once a date for resuming PA is established.