Medicare's Prior Authorization List Grows on October 28, 2026: What DME and O&P Suppliers Need to Know

On October 28, 2026, two Medicare DMEPOS lists get longer. Eight more items will need prior authorization before you deliver them, and 22 more will need a recent face-to-face visit and a written order on file before delivery. If you supply manual wheelchairs, back braces, knee braces or support surfaces, this affects orders you’re taking this week.

Here’s exactly what’s changing, why CMS made the change, and what to set up now so these orders don’t stall.

Eight more codes need prior authorization

CMS added eight HCPCS codes to the Required Prior Authorization List in a Federal Register notice published July 30, 2026. Six start nationwide on October 28:

HCPCS	Item	Prior auth starts
K0005	Ultralightweight wheelchair	October 28, 2026, nationwide
E0194	Air fluidized bed	October 28, 2026, nationwide
L1833	Knee orthosis, adjustable knee joints, off-the-shelf	October 28, 2026, nationwide
L0456	Thoracic-lumbar-sacral orthosis, flexible, customized to fit	October 28, 2026, nationwide
L0457	Thoracic-lumbar-sacral orthosis, flexible, off-the-shelf	October 28, 2026, nationwide
L0486	Thoracic-lumbar-sacral orthosis, triplanar, custom fabricated	October 28, 2026, nationwide

They join the 74 codes already on the list, such as power mobility devices and the knee and back orthoses added in earlier years. Prior authorization is a condition of payment: deliver one of these items without a provisionally affirmed request, and the claim won’t be paid.

Two upper-limb orthoses phase in by state

The elbow orthosis L3761 and the wrist-hand orthosis L3916 roll out in three phases:

Phase	Starts	States
1	October 28, 2026	California, Florida, Michigan, New York
2	January 26, 2027	Phase 1 states, plus Arizona, Georgia, Illinois, Massachusetts, Ohio, Oregon, Pennsylvania, Texas
3	April 26, 2027	All remaining states and territories

If you ship L3761 or L3916 into a phase 1 state, prior authorization applies on October 28. Everyone else has a few months, but it’s worth building the process now rather than in April.

22 more codes need a face-to-face visit and a written order before delivery

The same notice adds 22 codes to the Required Face-to-Face Encounter and Written Order Prior to Delivery List, bringing it to 105 codes. For these items, the treating practitioner must see the patient within the six months before the written order, and you need the written order before you deliver.

The new codes are:

• Wheelchairs: E1161, K0002, K0003, K0004, K0005, K0006, K0007, K0831
• Home ventilators: E0466, E0467, E0468
• Oxygen: K0738
• Air fluidized bed: E0194
• Back orthoses: L0456, L0457, L0486
• Lower limb orthoses: L1833, L1906, L1933, L1952
• Upper limb orthoses: L3761, L3916

Notice the overlap: K0005, E0194, L1833, the three back orthoses and the two upper-limb orthoses are on both lists. For those items you need the face-to-face visit, the written order and the prior authorization before delivery.

Why CMS is doing this

CMS points to improper payment rates found in its own audits. From 2023 to 2025, the improper payment rate ran about 40 to 48 percent for upper limb orthoses, 35 to 47 percent for lower limb orthoses, and 22.1 to 42 percent for manual wheelchairs. The notice also cites more than $1.5 billion in DMEPOS payments suspended for suspected fraudulent billing.

For suppliers doing it right, the takeaway is practical: documentation on these items will get checked before payment, not after. Orders that are missing a recent visit note or a clean written order will now stop at the front door.

What a prior authorization request needs

Under the program rules, the request has to show the item meets Medicare’s coverage, coding and payment rules. That means sending:

• The written order or prescription
• The relevant parts of the patient’s medical record
• Your own supporting documentation

The DME MAC reviews it and sends back a provisionally affirmed or non-affirmed decision. CMS says standard requests are decided within 7 calendar days and expedited requests within 2 business days. A non-affirmed request can be fixed and resubmitted.

What to do this week

1. Flag the codes at intake. Add K0005, E0194, L1833, L0456, L0457 and L0486 (and L3761 and L3916 if you ship to California, Florida, Michigan or New York) to whatever rule tells your team an order needs prior authorization.
2. Check the visit date on every affected order. For the 22 face-to-face codes, confirm the practitioner saw the patient within six months before the written order, before you deliver.
3. Plan for the wait. Build up to 7 days of review time into delivery dates for these items, and tell referral sources why.
4. Fix your packet once. Decide which record excerpts each item needs, so every request goes out complete the first time instead of coming back non-affirmed.
5. Watch for the next phase. Put January 26 and April 26, 2027 on the calendar if you supply upper-limb orthoses outside the phase 1 states.

Where Docflow fits

This is exactly the kind of change that turns into a backlog: more items needing paperwork, the same team handling it. Docflow flags affected orders as they come in, builds the request from the order and the patient’s records, submits it, checks back until there’s a decision, and writes the result back to your system. If something is missing, like a visit note outside the six-month window, it goes to your team before the request is sent, not after it’s denied.

If you’d like to see it on your own orders, book a call. Your first workflow can be live in 30 days.

Sources

• Federal Register, Updates to the Master List, the Required Face-to-Face Encounter and Written Order Prior to Delivery List, and the Required Prior Authorization List, published July 30, 2026
• CMS, Prior Authorization Process for Certain DMEPOS Items
• Noridian, CMS expands authorization requirements for 2026