Article Detail - JD DME

For DMEPOS items and supplies provided on a recurring basis, billing must be based on prospective, not retrospective, use. For DMEPOS products supplied as refills to the original order, suppliers must contact the beneficiary before 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, that existing supplies are expected to end, and to confirm any changes or modifications to the order. Contact the beneficiary or designee about refills must take place no sooner than 30 calendar days before the expected end of the current supply. For refill delivery, the supplier must deliver the DMEPOS product no sooner than 10 calendar days before the expected end of the current supply. 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 CMS website.