Article Detail - JA DME
Rules for Who Can Order DME, Prosthetics, Orthotics, and Supplies (DMEPOS)
The question about who can order DMEPOS and what Medicare requires of them is asked often.
Q1: Who can order DME, prosthetics, orthotics, and supplies?
A1: All claims for items billed to Medicare require a written order/prescription from the treating practitioner as a condition of payment.
Q2: Who is considered a "treating practitioner"?
A2: The term "treating practitioner" refers to a physician, physician assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS) as defined in section 1861(aa)(5) of the Social Security Act.
Physicians
- Doctor of medicine
- Doctor of osteopathy (including osteopathic practitioner) - must be licensed to practice medicine and surgery
- Doctor of dental medicine or dental surgery
- Doctor of podiatric medicine
- Doctor of optometry (optometrists can only order and refer DMEPOS products/services and laboratory or x-ray services payable under Medicare Part B)
Non-Physician Practitioners
These practitioners must follow the requirements set forth in the CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 5, Sections 5.2.3, 5.7, and 5.8
- Physician Assistants
- Clinical Nurse Specialists
- Nurse Practitioners
To qualify as an ordering provider, you must:
- Have an individual National Provider Identifier (NPI)
- Be enrolled in Medicare in either an "approved" or an "opt-out" status
- Be of an eligible specialty type
Items and services you can order and certify will depend on your specialty type. Contact your MAC if you have questions about what you can order and certify.
Q3: Does the treating practitioner have to fill out everything on the order?
A3: For DMEPOS items other than PMDs, someone other than the treating practitioner may complete certain required elements of the Standard Written Order (SWO); however, the SWO must be signed by the treating practitioner per the Standard Documentation Requirements Article A55426.
