The equipment prior-authorization change starting October 15
Starting October 15, CMS requires some newly enrolled equipment suppliers to get approval before delivering and billing certain items. It applies to the supplier, not to every patient or every product.
Beginning October 15, 2026, CMS is introducing what it calls probationary prior authorization for certain durable medical equipment, prosthetics, orthotics and supplies, usually shortened to DMEPOS. It applies to suppliers that are newly enrolled in Medicare, or that go through certain changes in ownership, and it covers a list of designated items.
It reads like a patient-facing rule and is not one. The requirement sits with the supplier. It arrives in the same month as the equipment-fraud crackdown covered earlier on this site.
| Start date | October 15, 2026. |
|---|---|
| Who it applies to | Newly enrolled DMEPOS suppliers, and suppliers with certain changes of ownership, effective on or after that date. |
| What they must do | Get prior authorization before furnishing a designated item and submitting the Medicare claim. |
| How long | A one-year probationary period, beginning with the supplier’s first bill for a listed item. |
| Which items | A CMS list of designated codes, including orthoses (braces) and related devices. CMS publishes the full list. |
| Who it does not apply to | Suppliers outside the new-enrollment and ownership-change group. The existing prior-authorization program is separate and continues. |
What prior authorization is
Prior authorization is a review that happens before an item is delivered and billed. The supplier sends the documentation to a Medicare contractor, which decides whether the request appears to meet coverage rules. A “provisional affirmation” means a later claim is likely to be paid, provided the other requirements are met. A non-affirmation means it likely would not be. The point is to catch items that do not meet the rules before Medicare pays for them, not after.
CMS has set the probationary version to move quickly. Its FAQ says the contractors send decision letters by the fifth business day after receiving a request, and there is a faster route when waiting could seriously jeopardize a patient’s health.
Why it is aimed at new suppliers
The logic is straightforward. A supplier that enrolled last month has no billing history to examine, so the review moves to the front: approval first, payment after. A supplier with years of claims behind it is in a different position, and the probationary period applies to the first kind. It is a way of looking closely at billing in the first year.
Also on The Second Half Guide The big trip, done right Not where to go — you know where you want to go. The logistics that decide whether the trip you have been imagining for years actually works. Read it →The rule is about who is billing, not about who is buying. A new supplier gets a year of closer review; an established one does not.
What a patient could notice
Most patients will notice nothing. The probationary program applies to newly enrolled or ownership-changing suppliers; established suppliers can still be subject to Medicare’s existing equipment prior-authorization requirements, which are a separate program. If you get one of the designated items from a supplier that is new to Medicare, the supplier has to have the approval in hand before it delivers the item and bills, which can mean a short wait. That is a reason to ask early rather than a reason to worry.
It is not a requirement that you do anything. The supplier submits the request. What you can do is ask the supplier whether the item needs prior authorization and whether it has been submitted, and keep the name and phone number of the person you spoke with.
Where it sits in Medicare
CMS runs this as one of its fee-for-service compliance programs, which means it concerns Original Medicare billing. Medicare Advantage plans set their own authorization rules, and those are separate from this one. The existing prior-authorization program for certain equipment continues to apply to suppliers generally; the probationary program is an additional layer for the newly enrolled.
Suppliers affected are told directly. CMS’s enrollment contractors send notification letters and welcome packets, so a new supplier is not left to discover the requirement on its own. For a patient, the practical effect is that a supplier should already know whether it is under the probationary rule.
If a request is not approved
A non-affirmation is not a dead end. CMS’s prior-authorization rules allow a supplier to correct the documentation and resubmit, and there is no cap on resubmissions. What does not work is billing around the process: a claim for a designated item without an affirmation is subject to denial. If a supplier tells you an item is on hold, the question to ask is what the contractor said was missing.
What it is not
It is not a new requirement for every piece of equipment, and it is not a change to what Medicare covers. The existing rules about orders and documentation still apply, including the required list of items that need a face-to-face visit and a written order before delivery, described in the piece on the equipment fraud crackdown. Prior authorization is an extra checkpoint for a defined group of suppliers and items, layered on top of those rules.
It does not change what you pay either. For covered equipment under Original Medicare, the usual cost is 20% of the Medicare-approved amount after the Part B deductible when the supplier accepts assignment; a supplier that does not accept assignment can cost more. The new checkpoint affects timing and billing, not those rules.
It is also not a sign that a supplier is doing anything wrong. A new business has to start somewhere, and this is a condition of starting.
Questions worth asking a supplier
None of these is a test a supplier should fail for being new. They are the questions an ordinary customer asks of any business that is about to bill a government program in their name. Is this item one that needs prior authorization? Has the request gone in, and when? Who is the practitioner whose order it rests on? If there is a delay, whom do I call? A supplier that is working correctly answers all four without difficulty.
What to check
- If you are getting equipment, ask whether the supplier is new to Medicare and whether the item needs prior authorization.
- Ask whether the request has been submitted and approved before you expect delivery.
- Your own practitioner’s order is still the starting point for any covered item.
- Check your Medicare Summary Notice or plan statement for equipment you did not receive, and report it to 1-800-MEDICARE.
The change is narrow and mostly invisible to people who already deal with established suppliers. Its significance is the direction: more scrutiny at the point where a new supplier first bills Medicare.
This is general fraud-prevention information, not a substitute for reporting an active scam. The official reporting and assistance resources linked above are the right next step if you or someone you know may be a target.
Where these facts come from
Checked on 10 October 2026 against the sources listed below. Dollar limits and program rules change — if you're reading this well after that date, verify the numbers at the links below.
- CMS — Probationary Prior Authorization Process for Newly Enrolled Suppliers of Certain DMEPOS Items — https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/prior-authorization-pre-claim-review-initiatives/probationary-prior-authorization-process-newly-enrolled-suppliers-certain-durable-medical-equipment
- CMS — Probationary Prior Authorization process, FAQs — https://www.cms.gov/files/document/dmepos-ppa-faqs.pdf
- CGS Medicare — Probationary Prior Authorization (PPA) for Certain Newly Enrolled DMEPOS Suppliers — https://www.cgsmedicare.com/jc/pa/probationary-prior-authorization.html
- Ossur — CMS Introduces Probationary Prior Authorization for Newly Enrolled DMEPOS Suppliers — https://www.ossur.com/en-us/professionals/ossur-rr/cms-introduces-probationary-prior-authorization-for-newly-enrolled-dmepos-suppliers
Edward Silva
Edward spent more than forty years as a computer professional — long enough to pick up one useful occupational habit: when somebody hands you a summary, go and read the actual documentation. He started The Second Half Guide after noticing that most writing aimed at people his age was either talking down to him or quietly selling him something, and that the plain facts — the dates, the thresholds, the dollar figures — were somehow the hardest part to find.
He's married, with two grown sons, both married themselves. He is not a financial adviser, an attorney or an insurance agent, and this site doesn't tell you what to do with your money. It tells you what the rules actually say, and links to where he checked.