Medicare 2026

Original Medicare Will Require Prior Authorization for More Braces, a Bed and a Wheelchair Starting Oct. 28, 2026

If you or someone you help uses Medicare-covered medical equipment, there's a change worth knowing about. Starting October 28, 2026, Original Medicare will require prior authorization — approval before the item is delivered — for several more types of durable medical equipment, including some back braces, a knee brace, an air-fluidized bed and an ultralightweight manual wheelchair. The change is nationwide and applies to Original Medicare's equipment benefit.

What's changing on October 28, 2026

CMS published a Federal Register notice on July 30, 2026 (CMS-6109-N) that expands the list of durable medical equipment, prosthetics, orthotics and supplies — "DMEPOS" for short — subject to required prior authorization under Original Medicare.

Six new codes join the list on October 28, 2026:

• Three thoracic-lumbar-sacral orthoses (back braces)
• One knee orthosis
• An air-fluidized bed (a specialized pressure-reducing support surface)
• An ultralightweight manual wheelchair

The 74 codes already on the prior authorization list continue to require it. These additions don't change what Medicare covers; they change the paperwork step that has to happen before the item is delivered and the claim is paid.

Two upper-limb braces — an elbow orthosis and a wrist-hand orthosis — follow a staggered rollout. Prior authorization for those items begins in four states (one in each of Medicare's four equipment-claims contractor regions) on October 28, 2026, expands to eight additional states on January 26, 2027, and applies in all remaining states and U.S. territories starting April 26, 2027.

What "prior authorization" means here

Under Medicare's DMEPOS prior authorization program, the supplier must send a prior authorization request to Medicare's review contractor before the item is furnished and before the claim is filed. The request includes the written order from the treating practitioner, relevant records from the patient's medical chart and supplier documentation. Medicare then issues a "provisional affirmation" (looks good — the claim is expected to be paid if everything else is in order) or a "non-affirmation" (something is missing or doesn't meet the rules).

Since January 1, 2025, CMS's review timeframe has been no more than 7 calendar days for standard requests and 2 business days for expedited requests. A request can be resubmitted if it comes back non-affirmed.

CMS says the point of prior authorization is to make sure Medicare patients aren't left on the hook for items that don't qualify for coverage. The agency says it can suspend the program if it finds prior authorization is creating barriers to care, and it specifically watches complaints that come in through 1-800-MEDICARE.

Also new: more items need a face-to-face encounter and written order

The same July 30, 2026 notice added 22 codes — including eight wheelchair codes, three home ventilators, an oxygen item, an air-fluidized bed and several back, leg and arm braces — to the list of items that require a face-to-face encounter with the treating practitioner and a written order before delivery. The encounter must occur within the 6 months before the written order. Medicare rules allow telehealth for the encounter when appropriate. With the exception of the upper-limb orthoses described above, the list updates in the notice take effect October 28, 2026.

Why CMS is doing this

In the notice, CMS pointed to results from its Comprehensive Error Rate Testing program showing high improper payment rates for the item categories it's targeting: roughly 40% to 48% for upper-limb orthoses, 35% to 47% for lower-limb orthoses and 22.1% to 42% for manual wheelchairs from 2023 to 2025. Prior authorization is designed to catch problems before the item is delivered rather than after.

CMS also finalized a process (in its December 2, 2025 final rule, CMS-1828-F) that lets DMEPOS suppliers with a provisional-affirmation rate of 90% or higher qualify for an exemption from required prior authorization. The first annual exemption cycle began June 1, 2026. In practice, that means some well-performing suppliers may not have to submit a prior authorization request for every item.

What this means for you

If your doctor orders one of the affected braces, the air-fluidized bed or the ultralightweight manual wheelchair on or after October 28, 2026, your supplier should handle the prior authorization paperwork. A few practical tips:

• Ask the supplier to confirm they've submitted a prior authorization request before scheduling delivery.
• Make sure your treating practitioner has documented the face-to-face encounter and signed a written order.
• If you believe prior authorization is delaying care you need, call 1-800-MEDICARE.

A quick note on the bigger Medicare calendar

Medicare's Annual Enrollment Period runs October 15 – December 7, 2026, with choices taking effect January 1, 2027. For 2027, the Part D out-of-pocket cap rises to $2,400 (up from $2,100 in 2026), the maximum Part D deductible any plan may charge is $700, and the Part D base beneficiary premium used in the late-enrollment penalty is $41.33. The Social Security Administration announced a 3.6% cost-of-living adjustment for benefits payable beginning January 2027. The 2027 Part B standard premium and deductible and the IRMAA income brackets have not yet been announced; CMS typically releases those figures in the fall.

If you have Medicaid or Extra Help, since 2025 you've had a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan or switch stand-alone plans. Full-benefit dual-eligible individuals may join an integrated D-SNP in any month.

Deciding between Medicare Advantage and Original Medicare (often paired with a Medigap policy and a stand-alone Part D plan) is personal. Advantage plans often bundle extras and have network and prior-authorization rules of their own; Original Medicare offers broad provider access but relies on separate coverage for drugs and most out-of-pocket costs. Weigh the trade-offs with your own doctors, prescriptions and budget in mind.

Where to learn more

For official, up-to-date information, visit Medicare.gov or call 1-800-MEDICARE (TTY 1-877-486-2048), available 24/7.