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Medicare Parts A and B Coverage and Prior Authorization

This article is based on the Social Security Act and other laws which describe covered and non-covered items and services and their payment under Part A and Part B. Originally, the Social Security Act did not authorize any form of “prior authorization” for Medicare services. The law was subsequently changed to allow prior authorization of limited items of Durable Medical Equipment and physicians services. Currently, Medicare does not pre-authorize coverage of any item or service that will receive payment under Part A or B, except for custom wheelchairs.

Download the Guidance Document


Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: July 10, 2009

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.