Dec 6, 2011

A new Centers for Medicare & Medicaid Services (CMS) policy going into effect early next year will require prior authorization for some medical devices and equipment for Medicare patients in seven US states.

The new policy will also require pre-payment of reimbursement claims for some medical devices across 11 US states.

These reimbursement policy changes are intended to cut down on improper payments.

According to a Massdevice analysis of the new CMS policy, the new prior authorization requirements target 15 procedures, including pacemaker and defibrillator surgeries, spinal fusion procedures and joint replacements. These requirements will be implemented in two phases: During the first three to nine months of 2012, Medicare administrators will conduct prepayment reviews of certain medical equipment claims, followed by outright implementation of prior authorization requirements.

The prior authorization policy will affect Medicare recipients in California, Florida, Illinois, Michigan, New York, North Carolina and Texas. Claim pre-payment requirements will impact California, Florida, Illinois, Louisiana, Michigan, Missouri, New York, North Carolina, Ohio, Pennsylvania and Texas.


  • Stewart Eisenhart