New Prior-Authorization Codes for DME Orders

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The Centers for Medicare & Medicaid Services, writing for the Health and Human Services Department, published 91 FR 47972 on July 30, 2026. Implementation of updates to the Master List, the Required Face-to-Face Encounter and Written Order Prior to Delivery List, and the Required Prior Authorization List, excluding upper limb orthoses, are effective October 28, 2026. The notice announces updates to Healthcare Common Procedure Coding System (HCPCS) codes on those three lists; appearing on the Master List is not the same as being placed on the Required Prior Authorization List.

When does the October deadline actually bite?

The controlling date for most of this update is October 28, 2026. That is the date the Health and Human Services Department set for implementation of the Master List changes, the Required Face-to-Face Encounter and Written Order Prior to Delivery List changes, and the Required Prior Authorization List changes, excluding upper limb orthoses, as stated in 91 FR 47972.

Upper limb orthoses are the exception named in the same DATES block. Prior authorization requirements for the upper limb orthoses will be implemented in three phases, according to 91 FR 47972. Phase one includes New York, Michigan, Florida, and California and is effective October 28, 2026. Phase two includes the States in phase one and Pennsylvania, Massachusetts, Ohio, Illinois, Texas, Georgia, Arizona, and Oregon and is effective a date the sealed abstract does not restate here. Phase three includes all States and territories not included in phases one and two and is effective a date the sealed abstract does not restate here.

The notice carries RIN 0938-ZC04 and amends the framework at 42 CFR Part 410 and 42 CFR Part 414. Current regulation text for those parts is on the eCFR. The lists themselves are maintained under the process described in 42 CFR Part 414 and the face-to-face and written-order rules in 42 CFR Part 410.

This page is scoped to a sealed, point-in-time index of 1086 federal rules issued by 11 agencies and published September 1, 2023 – September 1, 2026. It is a fixed snapshot, not a live feed, so a later list update is outside this edition unless CMS publishes another notice.

What actually changes on the three lists?

The document announces updates to the HCPCS codes on the Master List, on the Required Face-to-Face Encounter and Written Order Prior to Delivery List, and on the Required Prior Authorization List, according to the abstract in 91 FR 47972. Those are three different libraries. The Master List is the pool of items that may later be selected for a face-to-face encounter, a written order prior to delivery, or prior authorization. Only items that are selected and announced in the Federal Register become conditions of payment.

CMS is adding 20 HCPCS codes to the Master List and is removing none for this update, according to 91 FR 47972. The added Master List codes, quoted from Table 1 of that notice, are A4239, A4594, A6022, A6197, E0658, E0659, E0683, E0734, E0738, E0739, E2001, E2298, K0831, L0456, L0486, L1833, L1933, L1952, L3916, and L5827.

CMS is adding 22 HCPCS codes to the Required Face-to-Face Encounter and Written Order Prior to Delivery List, quoted from Table 2 of 91 FR 47972: E0194, E0466, E0467, E0468, E1161, K0002, K0003, K0004, K0005, K0006, K0007, K0738, K0831, L0486, L0456, L0457, L1833, L1906, L1933, L1952, L3761, and L3916. For those items, the treating practitioner is required to have a face-to-face encounter with the beneficiary within the 6 months preceding the date of the written order or prescription, consistent with 42 CFR Part 410.

CMS is adding eight HCPCS codes to the Required Prior Authorization List, quoted from Table 3 of 91 FR 47972: E0194, K0005, L1833, L0456, L0457, L0486, L3761, and L3916. The two newly added upper limb orthoses codes on that table are L3761 and L3916, and those two follow the three-phase calendar in the DATES section rather than a single nationwide date.

A code can sit on the Master List and still not require prior authorization. A4239, the supply allowance for a non-adjunctive, non-implanted continuous glucose monitor, is added to the Master List in Table 1 and is not among the eight codes added to the Required Prior Authorization List in Table 3 of 91 FR 47972. Treating every Master List addition as a prior-authorization item is the operational error this notice is easiest to make.

Who has to act before the lists take effect?

The notice is written for Medicare durable medical equipment, prosthetics, orthotics, and supplies. The reader who has to move is the billing lead at a DMEPOS supplier and the practice manager for the ordering physician, because the face-to-face encounter and the written order prior to delivery sit on the practitioner side, while prior authorization and claim submission sit on the supplier side, as framed in 91 FR 47972 and 42 CFR Part 410.

A supplier that dispenses any of the eight prior-authorization codes will need an approved prior authorization as a condition of payment once the applicable date arrives, under 42 CFR Part 414. A supplier that dispenses any of the 22 face-to-face and written-order codes will need the encounter documentation and the written order prior to delivery. An ordering practice that writes those items will need a documented encounter within the 6 months preceding the order.

The rule does not say that a supplier who never bills the added codes has a new filing duty. The rule does not say that commercial, Medicaid, or Medicare Advantage contractors automatically copy these lists. The rule does not say that a hospital outpatient department is exempt if it bills the same HCPCS codes as DMEPOS. Scope questions that the notice does not answer belong with a qualified professional who can read the supplier's enrollment, the contractor jurisdiction, and the actual claim type.

Related Medicare operational pages on this site include the hospital outpatient payment and prior authorization update, the Medicare program healthcare compliance note, and the IRF therapy-start and interdisciplinary-team timing guide. Those pages do not replace 91 FR 47972.

What should a practice have ready by the date?

Readiness is a mapping problem, not a policy rewrite. Each affected HCPCS code has to be tagged to the list it actually joined, the date that list becomes a condition of payment in the supplier's states, the owner of the encounter or the prior-authorization packet, and the system field that will block a delivery that is missing evidence.

1. Export every active HCPCS code the supplier has billed or has on order, then mark which codes appear in Table 1, Table 2, or Table 3 of 91 FR 47972.

2. Split the matches into three queues: Master List only, face-to-face and written order prior to delivery, and required prior authorization. Do not collapse those queues.

3. For L3761 and L3916, map the beneficiary's state against the three-phase calendar in the DATES section of 91 FR 47972 instead of using a single national switch.

4. For each Table 2 code, confirm the ordering practice can produce a face-to-face encounter record within the 6 months preceding the written order, as 42 CFR Part 410 requires.

5. For each Table 3 code, confirm the prior-authorization packet owner, the contractor submission path, and the delivery hold that waits for the decision.

6. Name a human owner for incomplete encounter notes and a separate human owner for a denied or pending prior authorization. Those are different records.

7. Keep the Federal Register notice next to the workflow so a later reviewer can see the source of the code list rather than a locally invented spreadsheet.

Brightree is the billing and inventory system many DME suppliers already use to store HCPCS items, delivery tickets, and claim status. Availity is the clearinghouse path many ordering practices and suppliers already use to check eligibility and to send payer transactions, including prior-authorization requests. Neither product is named in 91 FR 47972. The operational question is whether the item master in Brightree and the authorization queue in Availity still treat a newly listed code as an ordinary sale.

The rule does not say how a supplier must configure Brightree or Availity. The rule does not say that a timestamp in either system proves medical necessity. Those tools can hold the code, the ticket, and the payer response. A qualified professional still reads the encounter and the authorization decision.

What is the cost of missing the lists?

The notice makes prior authorization a condition of payment for the selected items under 42 CFR Part 414, and it makes a face-to-face encounter and a written order prior to delivery a condition of payment for the selected items under 42 CFR Part 410. Delivering an item on the Required Prior Authorization List without the required authorization, or delivering an item on the face-to-face list without the encounter and the written order, is a payment-condition miss, not a paperwork preference.

The rule does not say a civil money penalty amount for missing this update. The rule does not say a percentage recoupment, a lookback window, or a per-claim fine. Where the notice is silent on a dollar figure, this page does not invent one. The practical exposure is claim denial, delayed reimbursement, and a delivery that cannot be billed until the missing encounter or authorization is in the record.

A practice that waits until the first denial to learn that L0456 now needs prior authorization, or that E0466 now needs a face-to-face encounter, will spend the denial cycle reconstructing an encounter that 42 CFR Part 410 required before delivery. The October date is the planning line, not a suggestion.

How does a practice operationalize the update at volume?

Propagate the coverage and billing rule change across the practice: each affected policy, code, or workflow maps to the change it must reflect. US Tech Automations flags workflows still running on the old rule and routes the update to the compliance owner.

That is a flag-and-route job. US Tech Automations can mark a Brightree item that still has no prior-authorization hold, or an Availity queue that still treats L3761 as a national code before the beneficiary's state has entered its phase, and send that gap to the named owner. It cannot decide medical necessity, cannot approve a prior authorization, and cannot certify that a face-to-face note satisfies 42 CFR Part 410.

The useful volume pattern is one source event per code, not one generic “DME compliance” task. A Master List-only code needs a watch, not a delivery block. A Table 2 code needs an encounter and a written order before delivery. A Table 3 code needs a prior-authorization decision. Mixing those three into a single alert is how a supplier either over-holds inventory or ships an item that Medicare will not pay.

US Tech Automations can keep those three queues separate, attach the Federal Register table that put the code on the list, and escalate a missing owner. A qualified professional still decides whether a particular order is in scope. The same boundary applies to any other workflow layer the practice already runs: the software routes; the clinician or the compliance lead concludes.

What questions do billing leads still ask?

Does landing on the Master List mean the item now needs prior authorization?

No. The Master List is the library of items potentially subject to a face-to-face encounter, a written order prior to delivery, and/or prior authorization, according to 91 FR 47972. Only items selected and announced on the Required Prior Authorization List become prior-authorization conditions of payment under 42 CFR Part 414.

Which codes were added to the Required Prior Authorization List?

The notice adds E0194, K0005, L1833, L0456, L0457, L0486, L3761, and L3916, quoted from Table 3 of 91 FR 47972. L3761 and L3916 follow the three-phase upper limb orthoses calendar in the DATES section.

Were any codes removed from the Master List?

The notice states there are no HCPCS codes being removed from the Master List for this update, according to 91 FR 47972.

When does a face-to-face encounter have to occur?

For items on the Required Face-to-Face Encounter and Written Order Prior to Delivery List, the treating practitioner is required to have a face-to-face encounter with the beneficiary within the 6 months preceding the date of the written order or prescription, consistent with 42 CFR Part 410 as applied in 91 FR 47972.

Does the rule set a penalty dollar amount if a supplier misses the date?

The rule does not say. 91 FR 47972 makes the lists conditions of payment. It does not publish a civil money penalty figure for this update.

Can a workflow flag prove the supplier complied?

No. A flag can show that an encounter note or a prior-authorization decision is missing. Clinical and compliance owners review the underlying record. Software does not certify payment.

Key Takeaways

• 91 FR 47972, RIN 0938-ZC04, updates HCPCS codes on the Master List, the Required Face-to-Face Encounter and Written Order Prior to Delivery List, and the Required Prior Authorization List, under 42 CFR Part 410 and 42 CFR Part 414.

• Implementation of those updates, excluding upper limb orthoses, is effective October 28, 2026.

• CMS adds 20 Master List codes and removes none; it adds 22 face-to-face and written-order codes; it adds eight prior-authorization codes, of which L3761 and L3916 phase in by state.

• Appearing on the Master List is not the same as being on the Required Prior Authorization List.

• The notice does not publish a penalty dollar amount; missing a listed condition of payment is still a billing miss.

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Every date, citation, RIN, CFR reference, and figure in these posts is copied verbatim from the Federal Register and eCFR as of the snapshot date. Nothing is estimated, modeled, or extrapolated. This is not legal or tax advice.

Source: Federal Register / eCFR

This page is for informational purposes only. It is not legal or tax advice and does not create an attorney-client relationship. Read 91 FR 47972 and the current text of 42 CFR Part 410 and 42 CFR Part 414, and consult a qualified professional about a particular supplier, order, or claim.

Last reviewed: July 30, 2026

The exception path is the agentic workflow layer.