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Originally Published: February 12, 2014
Revised: September 29, 2020

The PWK Segment

When submitting claims to the DME MAC, you have the option of mailing, faxing or using esMD to send documentation to accompany your electronically-submitted DMEPOS claims. This is accomplished through the use of what is called the PWK (paperwork) segment. The PWK process works like this:

  • Submit an electronic claim, making sure to complete the PWK segment. NOTE: See the Electronic Claim Requirements (Loop 2300 & Loop 2400) section below for additional claim submission instructions.
  • After the claim has been accepted by CEDI, complete the PWK Fax/Mail/esMD Cover SheetPDF.
  • Mail, fax, or send via esMD with the PWK Fax/Mail /esMD Cover SheetPDF all necessary documentation.
  • We will process the claim and will refer to your submitted PWK documentation (if necessary for proper claim adjudication).

When considering whether or not to use the PWK segment, please keep the following tips in mind:

  1. Use of the PWK segment is entirely voluntary

    You are not required to use the PWK segment in any circumstance; it is entirely voluntary. Under current claim processing rules, if a Medicare contractor determines that additional information is needed to complete proper adjudication of a claim (for instance, due to an audit), then the contractor will send you a development letter requesting additional documentation. This process will not change. If you believe your claim may result in a development request, then it may be a good idea to include the documentation through the PWK process in order to expedite claim processing time.
  2. The NTE (note) segment is still a valid option

    Using the PWK segment is not always the best option for including additional claim information. The NTE (note) segment of an electronic claim is also available for you to include notes and information that may be important for the proper adjudication of the claim. Use of the PWK segment results in additional processing time due to the waiting period required for us to receive your mailed/faxed documentation. If you can use the NTE segment instead of the PWK segment, we encourage you to do so.
  3. Do not send PWK documentation unless it is needed

    Medicare rules and regulations require that you keep certain documentation on file in order to support the medical necessity and justification of your claims (detailed written orders, proof of delivery, etc.); however, you are not required to submit this documentation with your claim. We encourage you to only submit supporting claim documentation when you believe we require it in order to correctly process your claim.
  4. Use of the PWK segment does not guarantee that the DME MAC will review the submitted paperwork

    When processing your claims, we may look for additional information in the NTE segment or the PWK segment in order to complete your claim; however, use of the NTE segment or PWK segment does not mean that we will always review the information. We only look at your additional information when needed in order to properly process payment. For instance, if a claim is submitted with a modifier that precludes payment for the item, the claim will deny without our claim processors looking at the NTE or PWK segments.
  5. Do not use PWK for submitting Reopenings, Redeterminations, or any other type of requests

    Using PWK is NOT an acceptable form of submission for Reopenings, Redeterminations, or other types of requests. Additionally, if you attempt to send documentation for use with a pending reopening or redetermination request via PWK, our reopening or redetermination analysts will not be able to access the information, and therefore your documentation will not be factored into the determination of your request.

If you need help filing a Reopening or Redetermination request, refer to the Reopenings and/or Appeals pages on our website.

Electronic Claim Requirements (Loop 2300 & Loop 2400)

In the claim level PWK segment (Loop 2300) or line level segment (Loop 2400), use the following data elements to identify that a paper attachment is forthcoming:

PWK 01 (Attachment Report Type Code – Required) – Values are listed below:

Code Definition
03 Report Justifying Treatment Beyond Utilization Guidelines
04 Drugs Administered
05 Treatment Diagnosis
06 Initial Assessment
07 Functional Goals
08 Plan of Treatment
09 Progress Report
10 Continued Treatment
11 Chemical Analysis
13 Certified Test Report
15 Justification for Admission
21 Recovery Plan
A3 Allergies/Sensitivities Document
A4 Autopsy Report
AM Ambulance Certification
AS Admission Summary
B2 Prescription
B3 Physician Order
B4 Referral Form
BR Benchmark Testing Results
BS Baseline
BT Blanket Test Results
CB Chiropractic Justification
CK Consent Form(s)
CT Certification
D2 Drug Profile Document
DA Dental Models
DB Durable Medical Equipment Prescription
DG Diagnostic Report
DJ Discharge Monitoring Report
DS Discharge Summary
EB Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer)
HC Health Certificate HR Health Clinic Records
I5 Immunization Record
IR State School Immunization Records
LA Laboratory Results
M1 Medical Record Attachment
MT Models
NN Nursing Notes
OB Operative Note
OC Oxygen Content Averaging Report
OD Orders and Treatments Document
OE Objective Physical Examination (including vital signs) Document
OX Oxygen Therapy Certification
OZ Support Data for Claim
P4 Pathology Report
P5 Patient Medical History Document
PE Parenteral or Enteral Certification
PN Physical Therapy Notes
PO Prosthetics or Orthotic Certification
PQ Paramedical Results
PY Physician's Report
PZ Physical Therapy Certification
RB Radiology Films
RR Radiology Reports
RT Report of Tests and Analysis Report
RX Renewable Oxygen Content Averaging Report
SG Symptoms Document
V5 Death Notification
XP Photographs

PWK 02 (Report Transmission Code – Required) – Values are listed below:

Code Definition
BM By Mail
FX By Fax
EL Electronically using esMD via X12 275
FT File Transfer using esMD via XDR

PWK 05 (Identification Code Qualifier – Required with PWK02) – Values are listed below:

Code Definition
AC Attachment Control Number

PWK 06 (Identification Code – Required with PWK02)

PWK06 is a value assigned by the supplier to uniquely identify the documentation to be mailed or faxed. This is the attachment control number (ACN). The ACN must match the CAN on the PWK cover sheet. The maximum field length is 50.

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