Usual Maximum Amount of Supplies

Original Effective Date: 12/03/2009           
Revision Effective Date: 11/01/2013

Many of the DME MAC local coverage determinations (LCDs) have supplies or accessories with usual maximum quantities and frequency limits. Suppliers are not required to provide these amounts nor are beneficiaries required to accept supplies or accessories at this frequency or in quantities that exceed the amount they typically use. Reordering of supplies and accessories is based upon actual beneficiary usage. Suppliers must not dispense a quantity of supplies exceeding a beneficiary's expected utilization. Suppliers should stay attuned to atypical utilization patterns on behalf of their clients and verify with the ordering physicians that the atypical utilization is, in fact, warranted.

A beneficiary or their caregiver must specifically request refills of supplies before they are dispensed. The supplier must not automatically dispense a quantity of supplies on a predetermined basis, even if the beneficiary has "authorized" this in advance. As referenced in the Program Integrity Manual (Internet-Only Manual, CMS Pub. 100-08, Chapter 4.26.1) "Contact with the beneficiary or designee regarding refills should take place no sooner than approximately 7 days prior to the delivery/shipping date. For subsequent deliveries of refills, the supplier should deliver the DMEPOS product no sooner than approximately 5 days prior to the end of usage for the current product."

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