Ostomy Supplies Refill Requirements

For Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) provided on a recurring basis, billing must be based on prospective, not retrospective use. For DMEPOS items supplied as refills to the original order, suppliers must contact the beneficiary prior to dispensing the refill and not automatically ship on a pre-determined basis, even if authorized by the beneficiary. This shall be done to ensure that:

  • The refilled item remains reasonable and necessary; and,
  • Existing supplies are approaching exhaustion; and,
  • To confirm any changes or modifications to the order.

Contact with the beneficiary or designee regarding refills must take place no sooner than 14 calendar days prior to the delivery/shipping date. For delivery of refills, the supplier must deliver the DMEPOS product no sooner than 10 calendar days prior to the end of usage for the current product. This is regardless of which delivery method is utilized.

Additional information on ostomy supplies can be found in the Local Coverage Determination (LCD) L33828 and Policy Article A52487 on the Noridian website.

 

            Last Updated Tue, 28 Jun 2022 19:40:44 +0000