Medicare Expands Prior Authorization for Power Wheelchairs, Ventilators, and Other Home Equipment

CMS updated Medicare's program integrity requirements for durable medical equipment, prosthetics, orthotics, and supplies in late July 2026, adding items to three lists that determine how much documentation suppliers must provide before Medicare pays.

CMS added 20 Healthcare Common Procedure Coding System codes to the Master List of DMEPOS items potentially subject to conditions of payment, 22 codes to the Required Face-to-Face Encounter and Written Order Prior to Delivery List, and 8 codes to the Required Prior Authorization List. The newly added items include certain orthoses, power wheelchairs, home ventilators, oxygen equipment, and air-fluidized beds.

Items on the Master List may be selected for audits and enhanced coverage reviews. Items on the face-to-face list require an in-person physician visit and a written order before a supplier can deliver the item and seek Medicare reimbursement. Items on the prior authorization list require CMS approval before delivery; a supplier that skips this step risks nonpayment even if the equipment is otherwise covered.

CMS stated the update is intended to reduce improper payments and strengthen oversight of equipment categories that carry elevated fraud or billing error risk, while maintaining access for beneficiaries with genuine medical needs. Prior authorization requirements for newly added upper-limb orthoses will be phased in nationally rather than activated all at once.

Beneficiaries prescribed items on any of these lists should expect their physician to submit clinical documentation or a prior authorization request to Medicare before the supplier orders the equipment. Processing timelines vary by Medicare administrative contractor region.