Prescription Requirements

(A) The purchase of prosthetic equipment requires a written prescription signed by a licensed physician or an independent nurse practitioner. The prescription must be written on the prescriber's prescription form and must include the following information: (1) the member's name and address; (2) the member’s MassHealth identification number; (3) specific identification of the prescribed item; (4) medical justification for the use of the item, including the member’s diagnosis; (5) the prescriber's address and telephone number; and (6) the date on which the prescription was signed by the prescriber. (B) The provider must keep the prescription on file for the period of time required by 130 CMR 450.205: Recordkeeping and Disclosure.