PRESCRIPTION (ORDER) REQUIREMENTS (Confirm with your Local Payer)

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
February 23rd, 2016

All items billed to Medicare require a prescription. An order for each item billed must be signed and dated by the treating physician, kept on file by the supplier, and made available upon request. Items dispensed and/or billed that do not meet these prescription requirements and those below must be submitted with an EY modifier added to each affected HCPCS code. 

7-Element Orders 
The order, referred to as the 7-element order, that the supplier must receive within 45 days after completion of the face-to-face examination (see Policy Article) must contain all of the following elements:

  1. Beneficiary’s name
  2. Description of the item that is ordered. This may be general – e.g., “power operated vehicle”, “power wheelchair”, or “power mobility device”– or may be more specific.
  3. Date of the face-to-face examination
  4. Pertinent diagnoses/conditions that relate to the need for the POV or power wheelchair
  5. Length of need
  6. Physician’s signature
  7. Date of physician signature

The Supplier may provide a template order listing the seven required elements but is prohibited from completing any part of it. The treating physician completing the face-to-face requirements must write the 7-element order. The 7-element order may only be written after the completion of the face-to-face exam requirements. Refer to the Policy Article NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES section for information regarding the statutory requirements for PMDs.

A date stamp or equivalent must be used to document receipt date.

PRESCRIPTION (ORDER) REQUIREMENTS (Confirm with your Local Payer). (2016, February 23). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/prescription-order-requirements-confirm-with-your-local-payer-31615.html

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