The Four States Medicare Picked First
Eight HCPCS codes join Medicare's Required Prior Authorization List on October 28, taking it from 74 codes to 82. Six land nationwide. The two that carry $71.4 million, L3761 and L3916, roll out in three state phases that reach a quarter of the money this month and half of it by January.
New York, Michigan, Florida, California. Those four go first.
Six years ago, when CMS phased prior authorization onto microprocessor-controlled lower-limb prosthetics, the four were California, Michigan, Pennsylvania and Texas. Same list shape, different states, and the Required Prior Authorization List still carries both sets side by side in its effective-date column.
Neither set was drawn around utilization. The rule is one state per DME MAC jurisdiction, and that is the whole of it.
On October 28, eight HCPCS codes join that list, taking it from 74 codes to 82. Six of them land nationwide that morning.
The other two, L3761 and L3916, phase in by state: four states on October 28, eight more on January 26, 2027, everybody else on April 26, 2027.
We summed CY2024 Medicare allowed dollars on those two codes by state. Phase one reaches 24.8% of them (chart below).
Why These Four
New York is Jurisdiction A, Michigan is B, Florida is C, California is D. Clean coverage of the contractor map, and CMS says so in the rule: four states, "one in each DME MAC jurisdiction."
The contractor map and the billing map are different maps.
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