{"abstract":"This final rule establishes a prior authorization program for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items that are frequently subject to unnecessary utilization. This rule defines unnecessary utilization and creates a new requirement that claims for certain DMEPOS items must have an associated provisional affirmed prior authorization decision as a condition of payment. This rule also adds the review contractor's decision regarding prior authorization of coverage of DMEPOS items to the list of actions that are not initial determinations and therefore not appealable.","action":"Final rule.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2015/12/30/2015-32506.html","cfr_references":[{"chapter":null,"citation_url":null,"part":405,"title":42},{"chapter":null,"citation_url":null,"part":414,"title":42}],"citation":"80 FR 81674","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"These regulations are effective February 29, 2016.","disposition_notes":null,"docket_ids":["CMS-6050-F"],"dockets":[],"document_number":"2015-32506","effective_on":"2016-02-29","end_page":81707,"executive_order_notes":null,"executive_order_number":null,"explanation":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2015/12/30/2015-32506.xml","html_url":"https://www.federalregister.gov/documents/2015/12/30/2015-32506/medicare-program-prior-authorization-process-for-certain-durable-medical-equipment-prosthetics","images":{},"images_metadata":{},"json_url":"https://www.federalregister.gov/api/v1/documents/2015-32506?publication_date=2015-12-30","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2015-12-30/2015-32506/mods.xml","not_received_for_publication":null,"page_length":34,"page_views":{"count":28038,"last_updated":"2026-04-26 16:15:04 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2015-12-30/pdf/2015-32506.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2015-32506.pdf?1451396719","publication_date":"2015-12-30","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2015/12/30/2015-32506.txt","regulation_id_number_info":{"0938-AR85":{"issue":"201510","html_url":"https://www.federalregister.gov/regulations/0938-AR85/prior-authorization-process-for-certain-durable-medical-equipment-prosthetics-orthotics-and-supplies","title":"Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items (CMS-6050-F)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201510&RIN=0938-AR85&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"}},"regulation_id_numbers":["0938-AR85"],"regulations_dot_gov_info":{"supporting_documents":[],"comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=CMS_FRDOC_0001","supporting_documents_count":0,"docket_id":"CMS_FRDOC_0001","regulation_id_number":null,"title":"Recently Posted CMS Rules and Notices.","checked_regulationsdotgov_at":"2016-01-19T06:00:12Z"},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":81674,"subtype":null,"title":"Medicare Program; Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies","toc_doc":"Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies","toc_subject":"Medicare Program:","topics":["Administrative practice and procedure","Health facilities","Health professions","Medical devices","Medicare","Reporting and recordkeeping requirements","Rural areas","X-rays"],"type":"Rule","volume":80}