title: Medicare Program; Prior Authorization Process for Certain Durable   Medical Equipment, Prosthetics, Orthotics, and Supplies. Final rule.
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.
mesh_terms: D004389:Durable Medical Equipment / Q000191:economics*; D004864:Equipment and Supplies / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence*; D006278:Medicare / Q000191:economics* / Q000331:legislation & jurisprudence*; D009989:Orthotic Devices / Q000191:economics*; D019736:Prostheses and Implants / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics / Q000331:legislation & jurisprudence; D014481:United States