Medicare adds 8 codes to its DMEPOS prior authorization list for dates of service on or after October 28, 2026, which brings the list to 82 codes. CMS also adds 22 codes to the face-to-face and written order list, which moves that list from 83 items to 105.
The items are orthoses, an air fluidized bed and an ultralightweight manual wheelchair. Practices that order braces and mobility equipment will see more documentation requests from their suppliers.
What CMS added to the three lists
CMS published the update in the Federal Register on July 30, 2026 (notice 2026-15446). The notice touches three lists. The Master List is the pool of items CMS can pick from. The Required Prior Authorization List is a subset of that pool. The face-to-face and written order list is a second subset.
| List | Items before | Codes added | Items after (sum) |
|---|---|---|---|
| Master List | 530 | 20 | 550 |
| Required Prior Authorization List | 74 | 8 | 82 |
| Face-to-face and written order list | 83 | 22 | 105 |
Source: CMS, Federal Register notice 2026-15446, July 30, 2026. The "after" column is the sum of the two figures to its left.
The 8 prior authorization codes are E0194 (air fluidized bed), K0005 (ultralightweight wheelchair), L1833 (off-the-shelf knee orthosis), L0456, L0457 and L0486 (thoracic-lumbar-sacral orthoses), and L3761 and L3916 (off-the-shelf elbow and wrist-hand orthoses). Of the 8 codes, 6 are orthoses, 1 is a support surface and 1 is a wheelchair.
The 22 new face-to-face codes break down as 3 lumbar-sacral orthoses, 4 lower limb orthoses, 2 upper limb orthoses, 8 wheelchairs, 3 home ventilators, 1 oxygen code and 1 air fluidized bed. The list already held 46 power mobility devices that the statute requires.
Dates and the three-phase rollout
CMS gave at least 90 days of notice. Six of the eight codes start nationwide on October 28, 2026. The two upper limb orthosis codes, L3761 and L3916, roll out in three phases so CMS can test the process on smaller claim volumes first.
- Phase one, October 28, 2026: 4 states, which are California, Florida, Michigan and New York.
- Phase two, January 26, 2027: the 4 phase one states plus Arizona, Georgia, Illinois, Massachusetts, Ohio, Oregon, Pennsylvania and Texas, for 12 states in total.
- Phase three, April 26, 2027: all other states and territories.
CMS's DMEPOS page lists 7 prior authorization codes that began nationwide on April 13, 2026, drawn from 18 codes added to the Master List in January 2026. In 2024, CMS added 76 codes to the Master List and chose 9 for prior authorization.
Why CMS picked these items
CMS cites error rates from CERT, its improper payment audit program. From 2023 to 2025, improper payment rates ran about 40 to 48 percent for upper limb orthoses and 35 to 47 percent for lower limb orthoses. Manual wheelchairs ran 22.1 to 42 percent over the same years.
MedPAC's June 2026 report, as summarized by HME Business, puts the fiscal 2025 improper payment rate for DMEPOS suppliers at 24.2 percent. The overall Medicare fee-for-service rate was 6.6 percent. DMEPOS is the highest of any provider type in that report.
Billing growth drove a second group of picks. Eight of the 20 new Master List codes (A4239, A6022, A6197, K0831, L0456, L0486, L1833 and L3916) entered the list for aberrant billing. Each had at least 1,000 claims and at least $1 million in payments in the 12 months from July 2024 to June 2025, with payments up more than 30 percent from the prior 12 months. The other 12 codes entered on payment size plus a mention in an OIG, GAO or CERT report.
A priced item reaches the Master List only if a CERT, OIG or GAO report also names it. For 2026 the inflation-adjusted price floors are $614 for an average purchase fee and $62 for an average monthly rental fee. Items drop off the Master List 10 years after they are added unless a new report flags them again. L1833 shows how the list moves: CMS removed it in August 2024 and selected it again for prior authorization in July 2026.
CMS also states that its Fraud Defense Operations Center has reported more than $1.5 billion in DMEPOS payments suspended for suspected fraudulent billing.
What changes for an ordering practice
The supplier, not the practice, files the prior authorization request. The request must include the written order, the relevant medical record information and supplier documentation. The practice supplies the first two.
The face-to-face rule sets a clock. The practitioner's encounter with the patient must fall within the 6 months before the written order, and the order must reach the supplier before delivery. The regulation allows telehealth to meet the encounter requirement when appropriate.
CMS's DMEPOS page states that standard prior authorization reviews take no more than 7 calendar days, and expedited reviews take 2 business days. The new notice says CMS will publish final timelines for these items in later guidance. Suppliers with a provisional affirmation rate of 90 percent or higher can qualify for an exemption, with the first exemption cycle starting June 1, 2026.
CMS estimates the annual compliance burden for the whole DMEPOS prior authorization program at about $4.8 million for providers. A separate rule starts October 15, 2026: newly enrolled suppliers and suppliers with a 100 percent change of ownership must submit prior authorization requests for 40 codes during a one-year probationary period, per CGS Administrators, the Jurisdiction C DME MAC.
Sources
- Centers for Medicare & Medicaid Services, Medicare Program; Updates to the Master List, Required Face-to-Face Encounter and Written Order Prior to Delivery List, and Required Prior Authorization List (Federal Register notice 2026-15446), July 30, 2026
- Centers for Medicare & Medicaid Services, Prior Authorization Process for Certain DMEPOS Items, updated July 29, 2026
- CGS Administrators, Probationary Prior Authorization for newly enrolled DMEPOS suppliers, September 2, 2026
- HME Business, MedPAC: DMEPOS Suppliers Lead Medicare in Improper Payment Errors, June 23, 2026
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