Anthem to Implement Fees for Paper Claims and Paper Checks
CMS added 20 items to the Master List of DMEPOS Items Potentially Subject to Conditions of Payment, with no items removed.
Effective 10/28/26, certain items will require a face-to-face encounter, a written order prior to delivery, prior authorization, or both. To meet these requirements, you may need to:
- See the patient and provide a written order before delivering the item
- Obtain prior authorization from your Medicare Administrative Contractor before providing the item
Key updates:
- Face-to-Face Encounter and Written Order Prior to Delivery: 22 items added
- Prior Authorization: 8 items added
For additional details, see the MLN Matters® Article (PDF)
Source: MLN Connects 2026-07-30
Some of these changes are listed below.
| HCPCS | Description | Required Face to Face Encounter and Written order Prior to Delivery | Prior Authorization Required | Effective Date |
| L0456 | Thoracic-lumbar-sacral orthosis (TLSO), flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | X | X | 10/28/2026 |
| L0457 | Thoracic-lumbar-sacral orthosis (TLSO), flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf | X | X | 10/28/2026 |
| L0486 | Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated | X | X | 10/28/2026 |
| L1833 | Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the-shelf | X | X | 10/28/2026 |
| L1843 | Knee orthosis (KO), adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf | X | X | 10/28/2026 |
| L1906 | Ankle foot orthosis, multi-ligamentous ankle support, prefabricated, off-the shelf | X | 10/28/2026 | |
| L1933 | Ankle foot orthoses, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, off-the-shelf | X | 10/28/2026 | |
| L1952 | Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, off-the-shelf | X | 10/28/2026 | |
| L3761 | Elbow orthosis (EO), with adjustable position locking joint(s), prefabricated, off-the-shelf | X | X | P1: 10/28/26 (NY, MI, FL and CA) P2: 01/26/2027 (PA, MA, OH, IL, TX, GA, AR, and OR) P3: 04/26/2027 Nationwide |
| L3916 | Wrist hand orthosis (WHO), includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf | X | X | P1: 10/28/26 (NY, MI, FL and CA) P2: 01/26/2027 (PA, MA, OH, IL, TX, GA, AR, and OR) P3: 04/26/2027 Nationwide |