Probationary Prior Authorization Process for Newly Enrolled Suppliers of Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Warning:
Newly-enrolled DMEPOS suppliers must also participate in the wider required prior authorization process of certain high-risk DMEPOS items.
Background
Starting October 15, 2026, CMS will require probationary prior authorization for certain DMEPOS items billed by newly enrolled suppliers and suppliers undergoing certain changes of ownership.
This program is authorized under Section 1866(j)(3) of the Social Security Act and 42 CFR §424.527, which establishes a one-year probationary period for newly enrolled and ownership-changing DMEPOS suppliers. This probationary period begins when a supplier submits their first bill for one of the DMEPOS items on the Probationary Prior Authorization List (PDF).
Prior authorization allows suppliers to ensure that a DMEPOS item meets applicable Medicare coverage, payment, and coding rules before items are delivered. This advance review helps to protect the Medicare Trust Fund from improper payments while ensuring that beneficiaries can receive the DMEPOS items they need in a timely manner.
Timeline & Updates
Update 9/1/2026
Introduction of the Probationary Prior Authorization Process
Probationary prior authorization applies to newly enrolled suppliers and those undergoing certain changes of ownership effective on or after October 15, 2026.
See the full list of codes subject to Probationary Prior Authorization here (PDF). CMS may update this list if new vulnerabilities arise, and any changes will be posted on this website.
The Probationary Prior Authorization process will follow the same submission and review steps as the established Prior Authorization Process for Certain DMEPOS Items. For details, see the Operational Guide here (PDF).
Prior Authorization Process for Certain DMEPOS Items
The Probationary Prior Authorization Process does not replace the existing Prior Authorization Process for Certain DMEPOS Items. Suppliers participating in the Probationary Prior Authorization Process must continue to comply with the existing prior authorization requirements for applicable DMEPOS items.
For more information, visit the DMEPOS Prior Authorization webpage and see the full list of codes requiring prior authorization (PDF).
Page Last Modified:
09/01/2026 04:13 PM