Dear Alliance of Wound Care Stakeholders;

There are issues you might be interested in and that we will discuss on our upcoming call—I am giving details about each of these below:

  1. Today – June 4 – CMS Open Door Forum on prior authorization of support Surfaces 2-3 pm eastern Participant Dial-In Number: 5960428 Conference ID #: 1-800-837-1935
    Prior authorization is an issue that we are always keeping track of—the DME suppliers tend to favor this process since it is a vehicle to ensure that they will be paid. This line of thinking is different than those in the HBO community.
  2. AHRQ- CTP Technology Assessment—We spoke last week with AHRQ who acknowledged again their mistake and is working with ECRI to find an appropriate way in which we can comment on their next draft—which should be coming soon.
  3. Another AHRQ item--By July 22- AHRQ seeking feedback  on stakeholder use of evidence reviews
  4. PTAC sends its recommendations to HHS Secretary on wound care proposals. The letter is attached – much of this was addressed by Dr. Terrell at our meeting.

June 4 2019 CMS Open Door Forum on Prior Authorization of Support Surfaces

The Center for Program Integrity (CPI) will host a Special Open Door Forum (ODF) to invite Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) suppliers, physicians and other Medicare stakeholders to discuss the addition of Pressure Reducing Support Surfaces (PRSS) to the Required Prior Authorization List.

As announced in the Federal Register Notice 84 FR 16616, published on April 22, 2019, CMS has added the following five Healthcare Common Procedure Coding System (HCPCS) codes to the list of DMEPOS items that require prior authorization as a condition of payment:

  • E0193 Powered air flotation bed (low air loss therapy)
  • E0277 Powered pressure reducing air mattress
  • E0371 Nonpowered advance pressure reducing overlay for mattress length and width
  • E0372 Powered air overlay for mattress, standard mattress length and width
  • E0373 Nonpowered advanced pressure reducing mattress

Prior authorization for PRSSs will be implemented in two phases. Phase I will begin July 22, 2019. Prior authorization will be limited to one state in each of the four DME Medicare Administrative Contractor (MAC) jurisdictions as follows: California, Indiana, New Jersey, and North Carolina. Phase II will begin October 21, 2019 and expands prior authorization of these codes to the remaining states and territories.

The Special ODF will include a discussion on the process for submitting a prior authorization request to the designated MAC, the timeframes for the MAC to render their prior authorization decisions, and the subsequent claim submission process. Participants will be encouraged to submit questions or provide feedback that may be incorporated into our supporting documents, such as the frequently asked questions document or the operational guide.

Prior authorization helps ensure all relevant coverage, coding, and clinical documentation requirements are met before the item is furnished and before the claim is submitted for payment. Prior authorization also certifies that payment of DMEPOS items is appropriate, thereby working toward the prevention and identification of potential fraud, waste and abuse; the protection of the Medicare Trust Funds from improper payments; and the reduction of Medicare appeals.

This link will take you to our DMEPOS Prior Authorization page where slides will be posted in advance of the ODF:

You can find the Federal Register Notice here.

Feedback and questions for the Required Authorization for Pressure Reducing Support Surfaces and other DMEPOS items can be sent to:


To Assist Future Planning, AHRQ Seeks Feedback on Stakeholder Use of Evidence Reviews

AHRQ wants to know how people and organizations have used any of the more than 650 reports developed by the Agency’s Evidence-based Practice Center (EPC) Program.  If you or your organization has used an AHRQ evidence-based systematic review, please support future program planning by providing feedback by July 22.  AHRQ is interested in feedback from clinical professional organizations, payers, health systems, research funders and others on:

  • How you heard about the AHRQ EPC review
  • How you used the AHRQ EPC evidence review
  • How the AHRQ EPC evidence review changed your decision, recommendation, or action
  • What you would have done in the absence of an EPC report
  • Was the AHRQ EPC evidence review acknowledged or referenced in your decision, recommendation, or action? If so, how? And if not, why not?
  • Your assessment of the value of the unique contribution provided by AHRQ in conducting evidence reviews for improving patient care and outcomes
  • Based on your experiences, suggestions for how the EPC program can make its evidence reviews more useful and impactful

For more information see:

Feedback may be sent to

Marcia Nusgart, R.Ph.
Executive Director
Alliance of Wound Care Stakeholders
5225 Pooks Hill Road, Suite 627S
Bethesda, MD 20814
tel 301.530.7846  |  cell. 301.802.1410