Effective Jan. 1, 2027, we’re changing how prior authorization (PA) requirements are applied for certain durable medical equipment (DME) items. This change will impact all plans (Medicare, Medicaid and commercial / ACA).
What’s changing?
Currently, DME items require PA when they reach a dollar-value threshold. Beginning Jan. 1, PA requirements will no longer be based on the cost of the item. Instead, PA will be required for a subset of DME items – those that have typically fallen at or above the dollar-value threshold and which you may already be accustomed to getting PA for.
Our Authorization Quick Reference List will be updated on Jan. 1 to reflect the updated list of DME items requiring PA.