In 2015, CMS issued a final rule that established a prior authorization process for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items, with the goal of reducing the use of items that had been frequently subject to unnecessary utilization. Initial implementation began March 20, 2017, and items have been added and subtracted to the list over the following years through subsequent rulemaking. As of January 13, 2026, the DMEPOS items prior authorizations list includes over 70 items, including for pressure reducing support surfaces, power mobility devices, and lower limb prosthetics. Additionally, in December 2025, CMS issued a rule which establishes a prior authorization exemption process for certain DMEPOS items, allowing qualifying suppliers, such as those who show an affirmation rate of 90% or higher, to be exempt from prior authorization.
In a 2019 final rule (effective July 1, 2020), CMS established national prior authorization requirements for a set of hospital outpatient department services which had experienced significant increases in utilization and that are likely to be cosmetic procedures and not covered by Medicare, but may be combined with other therapeutic services, including blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty, and vein ablation. In further rulemaking (effective July 1, 2021), CMS added implanted spinal neurostimulators and cervical fusion with disc removal to the list of services requiring prior authorization, and another rule (effective July 1, 2023) added facet joint interventions.
The CMS Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Model uses the authority provided through the Center for Medicare and Medicaid Innovation (CMMI, or Innovation Center) to test whether prior authorization for non-emergent ambulances for certain medical appointments would save money for Medicare while maintaining access and quality of care. The model was first implemented in select states in December 2014 and was ultimately expanded nationwide in September 2020 as it met the model requirements, saving Medicare about $650 million over four years.
On January 1, 2026, the Center for Medicare and Medicaid Innovations (CMMI) launched the Wasteful and Inappropriate Service Reduction (WISeR) Model that establishes new prior authorization requirements in traditional Medicare for select services in six states (New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington). These services include skin substitutes (synthetic products used in the treatment of severe or chronic wounds), orthopedic pain management services, electrical nerve stimulator implants, incontinence control devices, and services related to the diagnosis and treatment of impotence. According to CMS, the model will test the use of enhanced technologies, such as artificial intelligence, to conduct prior authorization for services vulnerable to fraud or abuse.
