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Updated HCPCS Codes Requiring Prior Authorization – Medicare
Effective date
Oct 28, 2026
Identified
Nov 7, 2026
Summary
L.A. Care Health Plan now requires prior authorization for eight HCPCS codes for its Medicare members, following CMS's addition of those codes to the DMEPOS Required Prior Authorization List, effective October 28, 2026. Separately, 22 HCPCS codes were added to the Required Face-to-Face Encounter and Written Order Prior to Delivery list effective the same date, requiring a documented face-to-face encounter within six months before the written order and communication of the order to the supplier before delivery.
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What to do
Action · 8 steps
01Already effective October 28, 2026: Billing team and providers should verify each affected HCPCS code using L.A.
02Care's Prior Authorization Look-Up Tool before scheduling or supplying E0194, K0005, L1833, L0456, L0457, L0486, L3761, or L3916 for L.A.
03Care Medicare members, and obtain provisionally affirmed prior authorization through the L.A.
04Care Provider Portal, since claims subject to the list may not be eligible for payment without it.
05Providers should assemble the written order/prescription, relevant medical record information, and supplier-produced documentation before submitting, because incomplete requests may delay determination.
06Front desk and clinical staff should confirm that the treating practitioner's face-to-face encounter within six months before the written order is documented in the medical record for the F2F/WOPD codes listed (including L0456, L0457, L0486, L1833, L1906, L1933, L1952, L3761, L3916, the wheelchair codes E1161 and K0002-K0007 and K0831, home ventilator codes E0466-E0468, E0194, and K0738), and that the written order reaches the supplier before delivery.
07Update charge entry and claim edits so these codes are not released without an authorization number, and watch for further notices from L.A.
08Care Utilization Management at (877) 431-2273.
Codes mentioned
E0194K0005L1833L0456L0457L0486L3761L3916L1906L1933L1952E1161K0002K0003K0004K0006K0007K0831E0466E0467E0468K0738
Original notice
Updated HCPCS Codes Requiring Prior Authorization – Medicare
lacare.org · Always check the source before changing claims.
Related policy hubs
L.A. Care Health Plan policiesCA policy changesOrthopedicsPhysical TherapyPulmonologyGeneral PracticeCode E0194Code K0005Code L1833Code L0456Code L0457Code L0486Code L3761Code L3916Code L1906Code L1933Code L1952Code E1161Code K0002Code K0003Code K0004Code K0006Code K0007Code K0831Code E0466Code E0467Code E0468Code K0738