Guides / PA List
PA List CMS Required Prior Authorization List — 42 CFR 414.234The Medicare DMEPOS Required Prior Authorization List, explained (2026)
Citations verified against the CMS Medicare Coverage Database · Reviewed September 2026
For most DME, Medicare reviews documentation after the claim. For a specific list of items, it reviews before delivery: the supplier sends the packet to the DME MAC, gets an affirmed or non-affirmed decision, and puts the decision's tracking number on the claim. That list is the Required Prior Authorization List, created by 42 CFR 414.234 and updated by notice in the Federal Register.
As of the July 29, 2026 update the list has 74 codes in force and 8 more effective October 28, 2026 — 82 in all. This guide explains what being on the list changes, what it does not, and where the list is going. To check a single code, use the lookup tool.
The requirements, with citations
The mechanics below are drawn from the cited CMS regulation, list documents, and Federal Register notices — this page is not a rules-engine mirror.
A PA decision before delivery is a condition of payment
For a listed item, the supplier (or practitioner) submits the documentation to the DME MAC and receives a provisional affirmation or non-affirmation before delivery. A claim for a listed item submitted without a decision is denied.
42 CFR 414.234 — prior authorization for certain DMEPOS itemsThe 82 codes, by category
Power mobility devices (46 codes — power wheelchairs and scooters), orthoses (21 — spinal, knee, ankle-foot, and from October 2026 upper limb), lower limb prostheses (6), pressure reducing support surfaces (6), pneumatic compression devices (2), and one manual wheelchair base (K0005). Osteogenesis stimulators were removed in 2024.
CMS Required Prior Authorization List — updated July 29, 2026Eight additions effective October 28, 2026
L0456, L0457, L0486 (TLSO), L1833 (knee orthosis, re-added after its 2024 removal), E0194 (air-fluidized bed) and K0005 (ultralightweight manual wheelchair) nationwide; L3761 and L3916 (upper limb orthoses) phased by state. The same notice added 22 codes to the face-to-face and written-order-prior-to-delivery list.
Federal Register, July 30, 2026Phased rollouts are by the beneficiary's state
CMS sometimes starts a code in a handful of states before going nationwide — the upper limb codes begin in NY, MI, FL and CA on October 28, 2026, add PA, MA, OH, IL, TX, GA, AZ and OR on January 26, 2027, and cover every state on April 26, 2027. The beneficiary's permanent address decides.
Federal Register, July 30, 2026 — phased implementationDecision timeframes and resubmission
The DME MACs target five business days for a standard request and for resubmissions, and two business days for an expedited request. A non-affirmed request can be resubmitted with more documentation as many times as needed; requests are accepted starting two weeks before a code's effective date.
CMS DMEPOS prior authorization programThe list changes by Federal Register notice
Additions are announced with at least 60 days' notice — seven codes in the January 13, 2026 notice, eight in the July 30, 2026 notice. Removals happen too: osteogenesis stimulators in 2024, L1833 in 2024 (and back in 2026).
Federal Register, January 13, 2026What usually sinks these claims
- Delivering a listed item before the decision arrives — the claim is denied regardless of the documentation
- Reading the list by code family: L1832 has required PA since 2022 while its off-the-shelf twin L1833 did not until October 2026
- Missing a phased start because the beneficiary's state, not the supplier's, decides
- Treating an affirmed decision as a guarantee — technical denials (same-or-similar, proof of delivery) still apply
- Forgetting the tracking number (UTN) on the claim
Check any code in seconds.
The PA List lookup on this site runs on the same list AffirmDME uses inside a case — code, effective date, and state schedule — and the case form flags listed items as you type them.
Open the PA List lookupFAQ
How many DMEPOS codes require prior authorization?
82 as of October 28, 2026: 74 in force before that date plus the eight added by the July 2026 notice. The lookup tool on this site is generated from the same list.
If my item is not on the list, is documentation reviewed at all?
Yes — through prepayment review, Additional Documentation Requests, and post-payment audits. The same LCD criteria apply; the difference is when the review happens.
Does prior authorization change the LCD coverage criteria?
No. The reviewer applies the item's LCD and policy article. An affirmed decision means the packet supported coverage at the time of review.
What is the probationary prior authorization list?
A separate list of 40 codes that newly enrolled suppliers (and suppliers with a change of ownership on or after October 15, 2026) must obtain PA for during their first year. It runs alongside the Required PA List and does not replace it.
Get an email when the Required PA List changes.
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This guide summarizes Medicare requirements as implemented in AffirmDME's compliance engine, with citations to the governing sources. It is not legal or billing advice; LCDs and CMS policy change — always confirm against the current policy text linked above.
More guides
- Medicare ADR Letters: how to respond without losing the claim
- Medicare DME Documentation Requirements: the checklist every claim needs
- Medicare CPAP Documentation Requirements (E0601)
- Medicare Home Oxygen Documentation Requirements (E1390)
- Medicare BiPAP / RAD Documentation Requirements (E0470)
- Medicare Hospital Bed Documentation Requirements (E0260)
- Medicare Wheelchair & Power Mobility Prior Authorization (E1161)
- Medicare Knee Orthosis Documentation Requirements (L1833, L1832)
- Medicare TLSO Documentation Requirements (L0456, L0457, L0486)
- Medicare Air-Fluidized Bed Documentation Requirements (E0194)
- Medicare Ultralightweight Manual Wheelchair Requirements (K0005)
- Medicare Upper Limb Orthosis Requirements (L3761, L3916)
- Medicare Osteogenesis Stimulator Documentation Requirements (E0747, E0748)
- Probationary Prior Authorization for newly enrolled DMEPOS suppliers (Oct 15, 2026)
- The DMEPOS prior authorization exemption: how it works and how to keep it
- Which DME MAC handles your claim: Jurisdictions A, B, C, and D
- Standard Written Order (SWO) requirements for Medicare DME
- Medicare DME face-to-face encounter requirements
- Prior authorization vs ADR vs prepayment review vs TPE: what each means for a DME claim
- After a non-affirmed prior authorization: resubmit, deliver with an ABN, or wait
- Medicare DME proof of delivery requirements
- Preparing and submitting a DMEPOS prior authorization request
Unfamiliar term? The glossary defines ADR, SWO, UTN, PTAN and the rest; the PA List lookup checks any HCPCS code.