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U.S. Dept. of Health & Human Services
Medicare Fee-for-Service Compliance Programs: Medical Review and Education, Face-to-Face Encounter Requirement for Certain Durable Medical Equipment
Guidance for CMS developed a list of DME items subject to the Face-to-Face encounter requirements created by the rule. The list of DME items subject to Face-to-Face Encounter requirements may be found at: /Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/Downloads/DME_List_of_Specified_Covered_Items_updated_March_26_2015.pdf (PDF).
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 11, 2020
Effective January 1, 2020, CMS streamlined and simplified the order requirements for DMEPOS items (PDF), and outlined the process for identifying items that need a face-to-face encounter, written order prior to delivery, and/or prior authorization.
On January 13, 2022, the first iteration of the Required Face-to-Face Encounter and Written Order Prior to Delivery List (87 FR 2051) was published that announced 46 PMD codes per statute, and seven other DMEPOS items (one- osteogenesis stimulator and six- orthoses
On January 17, 2023, a second Federal Register Notice (88 FR 2546) was published that announced 10 additional orthoses that will require a face-to-face encounter and written order prior to delivery as a condition of payment.
On, May 13, 2024, a third Federal Register Notice was published that announced 13 additional codes (three- hospital beds, two- osteogenesis stimulators, six- lumbar sacral orthoses, and two- knee orthoses). One orthosis code was removed from the list due to its removal from the Master List.
Therefore, as of August 12, 2024, there is a total of 75 items on the Face-to-Face Encounter and Written Order Prior to Delivery List.
Any Medicare provider or supplier that writes DMEPOS orders or prescriptions will now use a standard set of elements that will be applicable to all DMEPOS items.
The treating practitioner must submit the complete written order to the supplier prior to submitting a claim for Medicare payment.
The Master List (PDF) is a library of all DMEPOS items posing vulnerabilities to the Trust Fund that may require providers/suppliers to comply with additional conditions related to payment requirements. From this list, items may be selected for one or both of the Required Lists:
Review contractors assess compliance with the face-to-face encounter and written order prior to delivery requirements. Some items (such as PMDs) have statutorily imposed requirements. For items that do not have statutory requirements, a face-to-face encounter and written order is required only if the item is selected from the Master List and placed on the Required Face-to-Face Encounter and Written Order Prior to Delivery List. Items selected for the list will be published in the Federal Register with no less than a 60-day Notice Period.
CMS may suspend the face-to-face encounter and written order prior to delivery requirements generally, or for a particular item or items, at any time and without creating a new rule, except for those items included on the Master List due to statutory mandate.
For items on the Required Face-to-Face Encounter and Written Order Prior to Delivery List, a complete order is required prior to the item’s delivery. (For all other DMEPOS items, the order is required prior to claim submission.)
CMS may suspend the face-to-face encounter and written order prior to delivery requirements generally, or for a particular item or items, at any time and without creating a new rule--except for items included on the Master List (PDF).
Medicare Learning Network—DMEPOS Written Order, Face-to-Face Encounter, and/or Prior Authorization Requirements (PDF): Learn more about the standard elements for a DMEPOS order and items potentially subject to face-to-face encounter and written order prior to delivery and/or prior authorization requirements.
Final Rule CMS-1713: The rule, finalized in 2019, streamlines the requirements for ordering DMEPOS items, and develops a new list of DMEPOS items potentially subject to a face-to-face encounter, written orders prior to delivery, and/or prior authorization requirements.
Federal Register Notice: This notice announces the items included on the Required Face-to-Face Encounter and Written Order Prior to Delivery List.
HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.
Date Published: 12/31/2020
