The Complete List of DME Codes Now Requiring Prior Authorization (Updated)

Keeping an accurate, current list of which DME HCPCS codes require prior authorization is one of those unglamorous tasks that quietly prevents a huge share of denials. CMS maintains three related but distinct lists — the Master List, the Required Face-to-Face Encounter/Written Order Prior to Delivery (F2F/WOPD) List, and the Required Prior Authorization List — and confusing which list a code sits on is a common, avoidable source of claim rejections. Here’s how the lists relate, what changed as of the April 13, 2026 update, and how to build a process that doesn’t rely on memory.

The three lists, and how they relate

CMS’s DMEPOS prior authorization framework is a funnel, not three parallel lists:

• The Master List is the broadest pool. It contains items CMS has identified as historically vulnerable to fraud, waste, or improper payment based on cost and utilization data. Being on the Master List does not, by itself, require prior authorization or a face-to-face encounter — it just means the item is a candidate CMS can move onto one of the two more restrictive lists below.
• The Required F2F/WOPD List is a subset of the Master List. Items on this list require a documented face-to-face encounter with the ordering practitioner and a written order prior to delivery before the supplier can bill Medicare for the item.
• The Required Prior Authorization List is a further subset. Items on this list require the supplier to submit a prior authorization request and receive a provisional affirmation before delivering the item and submitting the claim — this is the strictest tier, and the one that most directly determines whether a claim gets paid or denied outright.

In other words: every code on the Required PA List is also effectively subject to F2F/WOPD-level documentation expectations, but not every Master List code requires prior authorization. Denials often happen when a biller assumes a Master List code doesn’t need extra scrutiny, when it has actually already moved to the F2F/WOPD or PA tier in a more recent update.

What changed effective April 13, 2026

CMS’s most recent update to all three lists — issued with the standard 90-day advance notice — took effect April 13, 2026:

• Master List: 18 HCPCS codes added (8 identified through updated payment-threshold and fraud/improper-payment analysis, 10 flagged for aberrant billing patterns); none removed. The dollar thresholds that determine Master List eligibility were adjusted for inflation to $602 (purchase) and $61 (monthly rental).
• Required F2F/WOPD List: 8 codes added, all tied to oxygen and oxygen delivery equipment.
• Required Prior Authorization List: 7 codes added — 5 orthoses codes and 2 pneumatic compression device codes — bringing the total Required PA List to 74 HCPCS codes, up from 67 prior to the update.

The practical significance of the “74 codes” figure is that it’s now your master checklist. If a code your practice regularly bills isn’t in your current intake system’s PA-required flag, and it falls into orthoses, pneumatic compression, or oxygen equipment categories, that’s the first place to verify against the updated list.

Where to get the authoritative, current list

Because CMS updates these lists periodically and the exact code sets are lengthy, don’t rely on a static list from an article (including this one) as your source of truth for individual HCPCS codes — CMS and your MAC publish and maintain the authoritative versions:

• CMS’s Master List, F2F/WOPD List, and Required PA List pages under “Prior Authorization Process for Certain DMEPOS Items” on cms.gov, which are updated whenever a Federal Register notice takes effect.
• Your Durable Medical Equipment Medicare Administrative Contractor (DME MAC) jurisdiction page — Noridian (Jurisdictions A and D), CGS (Jurisdictions B and C) — which typically mirrors the current lists and adds jurisdiction-specific submission guidance.
• The Federal Register notice itself for the most recent update, which lays out exactly which codes were added, removed, or reclassified and the effective date.

Building a process that catches list changes before they cause denials

1. Assign ownership. One person or role (often a lead biller or compliance coordinator) should be responsible for checking CMS’s DMEPOS list pages on a recurring schedule — quarterly at minimum, since updates are announced with roughly 90 days’ notice and you want lead time to update intake systems before the effective date.
2. Tag your top-billed codes by list tier in your practice management or billing system — Master List only, F2F/WOPD required, or Prior Authorization required — so front-desk and intake staff get an automatic flag rather than relying on institutional memory.
3. Cross-reference new additions against your supply catalog immediately after each update, prioritizing categories CMS has recently expanded (oxygen equipment and orthoses, as of the April 2026 update).
4. Re-verify existing prior authorizations for patients with ongoing DME needs (like recurring oxygen supplies) when a code moves onto the Required PA List, since an authorization obtained before the code required PA won’t necessarily carry forward automatically.

Suppliers who manage this well tend to build a simple internal changelog — one line per update, listing effective date, codes added/removed, and which list tier changed — rather than just replacing an old spreadsheet each time. That changelog becomes invaluable when a claim from several months ago gets audited and you need to show exactly what the requirement was on the date of service, not the date of the audit.

Takeaway

The Required Prior Authorization List sits at 74 HCPCS codes as of April 13, 2026, with the newest additions concentrated in orthoses, pneumatic compression devices, and oxygen equipment. Pull the current list directly from CMS or your DME MAC, tag your billing system accordingly, and build a recurring review cadence rather than treating this as a one-time lookup.