Prescription (order) Requirements for Durable Medical Equipment

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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:

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:

 

References:

Prescription (order) Requirements for Durable Medical Equipment. (2015, November 24). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/prescription-order-requirements-for-durable-medical-equipment-27966.html

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