November 24th, 2015
The supplier for all Durable Medical Equipment, Prosthetic, and Orthotic Supplies (DMEPOS) is required to keep on file a physician prescription (order). A supplier must have an order from the treating physician before dispensing any DMEPOS item to a beneficiary.
The prescription is not a part of the patient documentation, however, you need to have a prescription on file and note the correct modifiers stating all conditions have been met (for Medicare). You may have better results attaching the prescription to the claim; however they say it is not necessary.
Prescription: The beneficiary’s physician must prescribe the customized equipment and provide information regarding the beneficiary’s physical and medical status to warrant the need for the equipment. Payment with respect to a covered item that is uniquely constructed or substantially modified to meet the specific needs of an individual beneficiary should be made in a lump-sum amount.
The following items are needed for coverage to be considered:
- Detailed description of the item
- Description of feature(s) that make this item unique
- Acquisition or production cost of the item, i.e., line item cost of materials and/or labor
A face-to-face examination is required each time a new prescription for one of the specified items is ordered. A new prescription is required by Medicare:
- For all claims for purchases or initial rentals
- When there is a change in the prescription for the accessory, supply, drug, etc.
- If a local coverage determination (LCD) requires periodic prescription renewal (i.e., policy requires a new prescription on a scheduled or periodic basis)
- When an item is replaced
- When there is a change in the supplier