Policy Resources
AFO/KAFO
- CMS DMEPOS Quality Standards
- Dear Physician Letter – Artificial Limbs and Braces (O&P)
- Dear Physician Letter – Knee Orthoses
- Replacement Orthosis During Reasonable Useful Lifetime Documentation Checklist
- Same or Similar Denials for Orthoses and the Appeals Process
Enteral Nutrition
External Infusion Pumps
- Billing for Home Infusion Therapy Services on or After January 1, 2021
- Dear Physician Letter – Insulin for Insulin Infusion Pumps
- Intravenous Immune Globulin Demonstration Ending: Important Information for IVIG and Infusion Suppliers
- MM10836 – Temporary Transitional Payment for Home Infusion Therapy Services for CYs 2019 and 2020
- Updated External Infusion Pump Policy – Parenteral Inotropic Therapy Frequently Asked Questions
General Documentation
- Additional Documentation Requests: Barcodes
- An Easy Option for Documenting Continued Use Dear Physician Letter
- Correct Coding – Partial Hand Prosthesis
- Items Provided on a Recurring Basis and Request for Refill Requirements – Annual Reminder
- JW Modifier Use – Correct Coding – Revised – Effective for Claims with Dates of Service On or After January 1, 2017
- Medicare Eligibility and Documentation Requirements for DMEPOS items Obtained Prior to Medicare Eligibility
- Standard Written Order (SWO) Resources
- Supplier Exit from Oxygen Equipment Business – Revised
Glucose Monitors
- Continuous Glucose Monitor (CGM) Use – Alternative Testing For Fingerstick Testing Requirements For Insulin Pumps
- Continuous Glucose Monitors Dear Physician Letter
- Glucose Monitors and Supplies Dear Physician Letter
Immunosuppressive Drugs
- Dear Physician – Immunosuppressive Drugs
- MM10235 – Clarification on the Billing of Immunosuppressive Drugs
- MM10370 – Special Requirements for Immunosuppressive Drugs
- MM11072 – Delivery of Immunosuppressive Drugs to Inpatient Facility
- SE17032 – Pharmacy Billing of Immunosuppressive Drugs
Lower Limb Prostheses
- Artificial Limbs, Braces, and Other Custom-Made Items and Incurred Expenses
- Dear Physician – Documentation of Artificial Limbs and Braces O&P)
- Lower Limb Protheses Checklist
- Lower Limb Prosthetic Required Prior Authorization
Manual Wheelchairs
Nebulizers
- Large Volume Nebulizers and Inhalation Drugs
- Nebulizers – Coverage Criteria and Physician Documentation Requirements
- Nebulizers and Inhalation drugs: Iloprost and Trepostinil
- Physicians! Are You Ordering Nebulizers and Inhalation Medication for Your Patient?
- Small Volume Nebulizers (A7003, A7004, A7005) & Related Compressor (E0570)
Negative Pressure Wound Therapy
Oral Appliances
- Oral Appliances for Obstructive Sleep Apnea Local Coverage Determination (LCD)
- Oral Appliances for Obstructive Sleep Apnea – Policy Article
- Standard Documentation Requirements for All Claims Submitted to DME MACs
Osteogenesis Stimulators
- Osteogenesis Stimulators Documentation Checklist (DME MAC Jurisdictions B & C) (cgsmedicare.com)
- Osteogenesis Stimulator Policy Revision – Frequently Asked Questions
Oxygen
- Revised Billing Instruction – Oxygen "Q" Modifiers and Medical Documentation
- MM10158 – Revised and New Modifiers for Oxygen Flow Rate
Positive Airway Pressure (PAP)
- Billing Reminder – PAP/RAD Accessories
- Confused by the Frequency of Replacement for PAP Accessories?
- MM9741 – Documentation for Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Claims for Replacement of Essential Accessories for Beneficiary – Owned Continuous Positive Airway Pressure (CPAP) Devices and Respiratory Assist Devices (RADs)
- PAP Frequently Asked Questions
- Positive Airway Pressure (PAP) Accessories and Supplies
- Positive Airway Pressure (PAP) Devices for the Treatment of OSA
Parenteral Nutrition
Power Mobility Devices
- Dear Physician Letter: Documentation Requirements for Power Wheelchairs and Power Operated Vehicles
- Power Mobility Device (PMD) Required Prior Authorization
- Power Mobility: Group 1 PWCs (K0813 – K0816) & Group 2 PWCs (K0820 – K0829)
- Power Mobility: Group 2 Single Power Option PWCs (K0835 – K0840) & Group 2 Multiple Power Option PWCs (K0841 – K0843)
- Power Mobility: Group 3 No Power Option PWCs (K0848 – K0855), Group 3 Single Power Option PWCs (K0856 – K0860), & Group 3 Multiple Power Option PWCs (K0861 – K0864)
- Practitioner & DMEPOS Supplier Information on Power Mobility Devices
Pressure Reducing Support Services
- Pressure Reducing Support Surfaces Prior Authorization
- Support Surfaces: Group 1 Pressure Reducing Support Surface
- Support Surfaces: Group 2 Pressure Reducing Support Surface
- Support Surfaces: Group 3 Pressure Reducing Support Surface
Respiratory Assist Devices
- Billing Reminder – PAP/RAD Accessories
- MM9741 – Documentation for Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Claims for Replacement of Essential Accessories for Beneficiary – Owned Continuous Positive Airway Pressure (CPAP) Devices and Respiratory Assist Devices (RADs)
- Respiratory Assist Device – E0470 Bi-Level Pressure Capacity Without Backup Rate
- Respiratory Assist Device – E0471 Bi-Level Pressure Capacity With Backup Rate
Surgical Dressings
Therapeutic Shoes for Persons with Diabetes
- Dear Physician – Therapeutic Shoes for Diabetics
- Nurse Practitioners and Physician Assistants as Certifying Physicians for Therapeutic Shoes and Inserts – 11.05.20
- Primary Care First Model Demonstration Project – Nurse Practitioners as Certifying Physicians for Therapeutic Shoes and Inserts – 11.05.20
- Therapeutic Shoes for Persons with Diabetes Activity Timeline
- Therapeutic Shoes for Persons with Diabetes Documentation Checklist
- Therapeutic Shoes for Persons with Diabetes: Know the Roles