Reminder: PECOS Edits for Referring/Ordering Physicians Scheduled for Implementation on May 1, 2013


The Centers for Medicare and Medicaid Services (CMS) has announced that it will implement Phase 2 of the PECOS referring/ordering physician edits for claims submitted on or after May 1, 2013.   What this means is that claims for services ordered by a physician or other eligible provider who does not have an active enrollment file in the PECOS system will be denied.

AOPA has recently received concerns from members regarding a CMS requirement that  referral sources must not only be registered in PECOS, but also must indicate that they will prescribe orthotic and prosthetic services in order for claims for services they prescribed to be processed by the DME MACs.  While CMS has indicated that in addition to registering in PECOS, prescribing providers must be eligible to prescribe DMEPOS, there is currently no requirement that prescribing providers indicate that they will prescribe O&P services specifically.  The specialty types listed as eligible to prescribe DMEPOS include the following:

-M.D. -Physician Assistant
-D.O. -Certified Clinical Nurse Specialist
-Doctor of Dental Medicine or Dental Surgery -Nurse Practitioner
-Doctor of Podiatric Medicine -Doctor of Optometry

The list above represents no change to the historical list of provider specialties that may prescribe DMEPOS, including orthotic and prosthetic services so it’s impact on O&P providers should be minimal.

It remains important that AOPA members confirm that their referral sources are properly enrolled in PECOS in order to avoid unnecessary claim denials on or after May 1, 2013.

Questions regarding this issue may be sent to Joe McTernan or Devon Bernard.