DME MAC JURISDICTION C - CGS

Supplier Documentation Chapter 3Medicare coverage for all items and services furnished or ordered by chiropractors, with theexception of treatment by means of manual manipulation of the spine to correct a subluxation, isstatutorily excluded. Therefore, all DMEPOS items ordered by chiropractors are denied.Medicare coverage for all items and services furnished or ordered by podiatrists is limited by Statestatutes governing the scope of practice for podiatry. DMEPOS suppliers should be familiar with thelimitations imposed by the statutes of the states in which they operate and dispense DMEPOS items.Claims submitted to the DME MAC, when furnished or ordered by podiatrists practicing outside thelimits of their licensures, will be denied as statutorily non-covered. Podiatrists are excluded bystatute from ordering a power operated vehicle (POV) or power wheelchair.OrdersDISPENSING ORDERSSuppliers must have an order from the treating physician before dispensing a DMEPOS item to abeneficiary. Except for items requiring a written order prior to delivery, the dispensing order may be awritten, fax or verbal order. The dispensing order must include:• A description of the item;• The beneficiary's name;• The name of the physician; and• The date of the order.The supplier must maintain written documentation of the dispensing order and this documentationmust be available upon request. Except for items requiring a written order prior to delivery (seebelow), if the supplier does not have an order from the treating physician before dispensing an item,it will be denied as not medically necessary.Written OrdersWritten orders are acceptable for all transactions involving DMEPOS. Written orders may take theform of a photocopy, facsimile image, electronically maintained, or original "pen-and-ink" document.(Reference: CMS Manual System, Pub. 100-08, Medicare Program Integrity Manual, Chapter 3,section 3.4.1.1.B.)All orders must clearly specify the start date of the order.For items that are dispensed based on a verbal order, the supplier must obtain a written order thatmeets the requirements of this section.If the written order is for supplies that will be provided on a periodic basis, the written order shouldinclude appropriate information on the quantity used, frequency of change, and duration of need.(For example, an order for surgical dressings might specify one 4 x 4 hydrocolloid dressing that ischanged 1-2 times per week for 1 month or until the ulcer heals.)The written order must be sufficiently detailed, including all options or additional features that will beseparately billed or that will require an upgraded code. The description can be either a narrativeDME MAC Jurisdiction C Supplier Manual Page 2