Article Detail - JD DME

For all DMEPOS items, the initial justification for medical need is established at the time the item(s) is first ordered. Beneficiary medical records demonstrating that the item is reasonable and necessary are created just prior to, or at the time of, the creation of the initial prescription.

Once initial medical need is established, unless continued coverage requirements are specified in the LCD, ongoing need is assumed to be met. There is no requirement for further documentation of continued medical need as long as the beneficiary continues to meet the Prosthetic Devices benefit. For more information please review the policy articles for Urological Supplies A52521 or Ostomy Supplies A52487.