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April 6, 2018Revised 12.08.20

Physicians/Practitioners! Medical Records Play a Vital Role in Ordering and Providing DMEPOS to Your Patients!

For any Durable Medical Equipment, Prosthetic, Orthotic and Supply (DMEPOS) item to be covered by Medicare, the patient's medical record must contain sufficient information about the patient's medical condition to substantiate the necessity for the type of equipment or supply, quantity and/or frequency of use or replacement, if applicable.

In addition to the Standard Written Order (SWO), there must be documentation from the medical record to support medical necessity and should include pertinent and relevant information such as:

  • Patient's diagnosis
  • Duration of the patient's condition
  • Clinical course (worsening or improvement)
  • Prognosis, nature and extent of any functional limitation(s)
  • Other therapeutic interventions and results, past experience with related items, etc.

For selected claims, various auditing entities may request this information from the DME supplier. These DME suppliers are your partners in caring for your patients. They will not receive payment from Medicare for the items that are ordered if you do not provide information from your medical records when it is requested. In addition, without sufficient information from your medical records supporting the item(s) that you ordered, the DME supplier may have to use an Advance Beneficiary Notice of Non-coverage (ABN), which will result in your patients having to pay for the items out-of-pocket.

Refer to the Local Coverage Determinations (LCDs) and Policy Articles (PAs) located at the links below for additional information regarding coverage criteria of specific DMEPOS items.

DMEPOS Jurisdictions

  • Jurisdiction A - CT, DE, MA, ME, MD, NH, NJ, NY, PA, RI, VT, Washington D.C.
  • Jurisdiction B - IL, IN, KY, MI, MN, OH, WI
  • Jurisdiction C - AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, Puerto Rico, SC, TN, TX, USVI, VA, WV
  • Jurisdiction D - Am. Samoa, Guam, N. Mariana Is., AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY


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