Medicare DMEPOS Prior Authorization Expansion Effective April 13, 2026

Date: March 01, 2026

To: Providers, Billing & Compliance Teams

From: Compliance & Coding Department

Subject: Action Required: Medicare DMEPOS Prior Authorization Expansion — Effective April 13, 2026

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Bottom Line

Starting April 13, 2026, seven new HCPCS codes require prior authorization (“P/A”) from Medicare nationwide. Five are orthoses codes (L0651, L1844, L1846, L1852, L1932) and two are pneumatic compression device codes (E0651, E0652).

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Who This Affects

This memo applies specifically to practices that:

• Dispense back braces, knee braces, or AFOs directly to Medicare patients (in-house dispensing)

• Are enrolled as a DMEPOS supplier with an active PTAN

• Bill Medicare for orthoses under HCPCS L-codes

If your practice refers patients to a separate DME supplier for their brace, the P/A obligation falls on that supplier — not your practice. This memo applies only if your practice is the dispensing entity.

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Required Prior Authorization — Orthoses Codes (All Medicare, Nationwide)

The table below lists all orthoses codes currently subject to required P/A. Codes marked ★ are newly added effective April 13, 2026. Highlighted rows (gold) indicate new codes requiring immediate workflow updates.

Code	Description	Type	Effective
Back Braces (Lumbar-Sacral Orthoses — LSO)
L0631	LSO, sagittal control, rigid anterior/posterior panels	Prefab, Custom Fitted	08/12/2024
L0637	LSO, sagittal-coronal control, rigid anterior/posterior frame/panels	Prefab, Custom Fitted	08/12/2024
L0639	LSO, sagittal-coronal control, rigid shells/panels	Prefab, Custom Fitted	08/12/2024
L0648	LSO, sagittal control, rigid anterior/posterior panels	Prefab, Off-the-Shelf	10/10/2022
L0650	LSO, sagittal-coronal control, rigid anterior/posterior frame/panels	Prefab, Off-the-Shelf	10/10/2022
L0651 ★	LSO, sagittal-coronal control, rigid shells/panels	Prefab, Off-the-Shelf	04/13/2026 NEW
Knee Braces (Knee Orthoses — KO)
L1832	KO, adjustable knee joints, positional orthosis, rigid support	Prefab, Custom Fitted	10/10/2022
L1843	KO, single upright, adjustable flex/ext joint, med-lat & rotation control	Prefab, Custom Fitted	08/12/2024
L1844 ★	KO, single upright, adjustable flex/ext joint, med-lat & rotation control	Custom Fabricated	04/13/2026 NEW
L1845	KO, double upright, adjustable flex/ext joint, med-lat & rotation control	Prefab, Custom Fitted	08/12/2024
L1846 ★	KO, double upright, adjustable flex/ext joint, med-lat & rotation control	Custom Fabricated	04/13/2026 NEW
L1851	KO, single upright, adjustable flex/ext joint, med-lat & rotation control	Prefab, Off-the-Shelf	10/10/2022
L1852 ★	KO, double upright, adjustable flex/ext joint, med-lat & rotation control	Prefab, Off-the-Shelf	04/13/2026 NEW
Ankle-Foot Orthoses (AFO)
L1932 ★	AFO, rigid anterior tibial section, total carbon fiber or equal material	Prefab, Custom Fitted	04/13/2026 NEW
L1951	AFO, spiral (IRM type), plastic or other material, prefabricated	Prefab, includes fitting	08/12/2024

★ = New as of April 13, 2026 | Source: CMS Required Prior Authorization List, updated January 13, 2026

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Prior Authorization Process for In-House Dispensing Practices

When your practice is the dispensing supplier, your team is responsible for obtaining the P/A — not a separate DME company. The process runs through the DME MAC for your jurisdiction (see table below), not your standard Part B MAC.

Key process details:

• P/A requests must be submitted to your DME MAC before the brace is dispensed to the patient

• Standard review turnaround is 5 business days (not to exceed 7 calendar days)

• Expedited review (2 business days) is available when delay could jeopardize patient health — must include physician rationale

• P/A approvals for orthoses are valid for 60 calendar days from the affirmation date

• Bilateral brace requests can be submitted on one P/A request — documentation must support the need for both sides

• Acute/emergent situations: Use the ST modifier to bypass P/A when the brace is needed immediately. Claims with the ST modifier are subject to 50% prepayment review.

Note: Practices can begin submitting P/A requests for the new April 13 codes starting March 30, 2026.

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DME MAC Jurisdictions by State

Claims for DMEPOS are submitted to the DME MAC serving the state where the Medicare beneficiary permanently resides — not where your practice is located. Identify your jurisdiction below and ensure your team is enrolled and submitting P/A requests to the correct contractor.

Jurisdiction	DME MAC Contractor	States Covered (WISeR states highlighted)
Jurisdiction A	Noridian Healthcare Solutions	CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VT ► WISeR State: New Jersey
Jurisdiction B	CGS Administrators	IL, IN, KY, MI, MN, OH, WI ► WISeR State: Ohio
Jurisdiction C	CGS Administrators	AL, AR, CO, FL, GA, LA, MS, NC, NM, OK, PR, SC, TN, TX, VA, VI, WV ► WISeR States: Oklahoma, Texas
Jurisdiction D	Noridian Healthcare Solutions	AK, AZ, CA, GU, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY ► WISeR States: Arizona, Washington

DME MAC portals for P/A submission:

  • Noridian (Jurisdictions A & D): med.noridianmedicare.com — Noridian Medicare Portal (NMP)

• CGS (Jurisdictions B & C): cgsmedicare.com — CGS Wizard portal or esMD electronic submission

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Documentation Requirements

Every P/A request must include the following, regardless of which DME MAC receives it: • Face-to-face encounter documentation within 6 months preceding the order, including subjective/objective findings supporting medical necessity

• A complete Standard Written Order (SWO) — must be in the supplier's possession before the item is dispensed

• For custom fabricated orthoses (L1844, L1846): documentation of why a custom fabricated device is medically necessary versus a prefabricated option

• For knee orthoses (L1843, L1844, L1845, L1846, L1851, L1852): objective documentation of joint instability (e.g., varus/valgus instability testing, anterior/posterior Drawer test) — subjective statements of instability are not sufficient

• Diagnosis codes (ICD-10) supporting medical necessity must be included on the claim line

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Recommended Action Items

• Audit your brace dispensing workflow now. Identify which of the 15 orthoses codes your practice bills most frequently and confirm P/A is already in place for codes that have been required since 2022 and 2024.

• Flag the 5 new codes in your EMR/PM system. L0651, L1844, L1846, L1852, and L1932 will trigger denials without P/A for dates of service on or after April 13, 2026. PARs can be submitted starting March 30.

• Confirm your DME MAC enrollment. Verify your practice has an active PTAN and portal access with the correct DME MAC for your patients' states. If you serve patients across multiple states, you may need access to more than one jurisdiction.

• Train your front-end and clinical documentation staff. Staff ordering or dispensing braces must understand the face-to-face documentation requirements and the difference between custom fitted vs. custom fabricated coding.

• Review your pipeline. Any brace orders pending delivery on or after April 13 for the new codes should be reviewed now to ensure P/A is in progress.

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— End of Memo —

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