Rules Concerning DMEPOS Orders/Prescriptions

5.2 – Rules Concerning DMEPOS Orders/Prescriptions (Rev. 10190; Issued: 06-19-2020; Effective: 01-01-2020; Implementation: 07-01- 2020) A written order/prescription is a written communication from a treating practitioner that documents the need for a beneficiary to be provided an item of DMEPOS. As used throughout this chapter, treating practitioner means a physician, as defined in section 1861(r)(1) of the Act, or physician assistant, nurse practitioner, or clinical nurse specialist, as those terms are defined in section 1861(aa)(5) of the Act. All DMEPOS items require a written order/prescription from the treating practitioner for Medicare payment as a condition of payment. Certain items require an order/prescription based on statute. In such instances, if the statutory requirements related to the order are not met, the claim will be denied as not meeting the benefit category. If the error cannot be cured, or can be cured but it is not cured within the prescribed timeframe, there may be financial implications for the beneficiary (see Pub. 100-04, Chapter 30, for more information on limitation on liability). A supplier must maintain the written order/prescription and the supporting documentation provided by the treating practitioner and make them available to CMS and its contractors upon request. In those limited instances in which the treating practitioner is also the supplier and is permitted to furnish specific items of DMEPOS and fulfill the role of the supplier in accordance with any applicable laws and policies, a separate SWO is not required. However, the medical record must still contain all of the required SWO elements.