DME MAC DMEPOS
​
Documentation Requirements

• For any 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 and quantity of items ordered and for the frequency of use or replacement (if applicable).


• The information should include the patient's diagnosis and other pertinent information, as applicable, such as:​​

– Duration of the patient's condition

– Clinical course (worsening or improvement)

– Prognosis, nature, and extent of functional limitation
– Other therapeutic interventions, and results

– Past experience with related items, etc.

Physician Order Form

Click the image below to download a digital copy of the Physician Order form to send to your medical doctor. Once it is completed by your physician there are 3 options for submitting the order and clinical notes documenting medical necessity.  Both the order and the clinicals are required to proceed.  

• email it to [email protected]
• upload it along with your application/ authorization form on the Online Ordering tab 
• fax it to 833-513-0978