The following questions and answers (Q&As) are cumulative from the DMEPOS Ask the Contractor Meeting (ACM) held on May 12, 2026. Some questions have been edited for clarity and answers may have been expanded to provide additional explanation. Similar questions were combined to eliminate redundancy. If a question was specific to one supplier’s claim or situation, Noridian addressed it directly with the supplier outside of the ACM.

Questions Received Prior to ACM

Q: For DME claims (e.g., L3933 (finger orthosis (FO)), if Medicare denies a service with a CO (contractual obligation) denial code such as CO-119 or CO-151, and we have a valid, properly signed Advance Beneficiary Notice of Noncoverage (ABN) on file, are we required to receive a PR (patient responsibility) denial status from Medicare before billing the patient? Or can we legally bill the patient directly based on the ABN without needing to appeal the claim to change the denial from CO to PR?
A: An ABN applies only to medical necessity denials. The example provided under CO‑119 (benefit maximum reached) is not a medical necessity denial; therefore, an ABN does not apply. However, denial CO‑151 (payment adjusted because the payer determined that the information submitted does not support the frequency or number of services billed) is considered a medical necessity denial. In this case, if the service is billed with the GA modifier and a properly executed ABN is on file, liability may shift to the beneficiary, resulting in a PR denial. Without the appropriate modifier billed, the beneficiary cannot be held financially liable.

• Noridian Medicare website > Browse by Topic > Advance Beneficiary Notice of Noncoverage (ABN)

Q: For continued coverage of continuous glucose monitor (CGM) supplies, does a patient merely have to be seen by their doctor so it can be documented that they are adhering to their CGM regimen and diabetes treatment plan? Meaning, no other documentation is needed showing the patient continues to need insulin or continues to have hypoglycemic events? As an example: If the Medicare patient starts with insulin and then comes off it because they are controlling their diabetes, they could continue to use CGM as long as every six months they get their follow-up completed to document adherence to the CGM regimen and diabetes treatment plan. Correct?
A: The determination of continued CGM coverage relies on the treating practitioner’s clinical judgment and supporting medical record documentation that meets CGM policy criteria.

• Noridian Medicare website > Browse by DMEPOS Category > Glucose Monitors

Q: Please provide an example of a labor narrative. “E1399 blower 30 minutes PO E0601” or “E0601 30 minutes”, which example is correct?
A: Items billed with any HCPCS code with a description that includes miscellaneous, not otherwise classified (NOC), unlisted, or non-specified, must include the following information in loop 2400 (line note), segment of the electronic claim format or on Item 19 of the paper claim form in the narrative field. Enter as much information for claim processing.
Required elements in narrative:

• Description of the item or service
• Manufacturer name
• Product name, model name and number
• Supplier Price List (PL) amount
• HCPCS code of related item (if applicable)
• If repair part, HCPCS code of item being repaired

Example "Blower, Manufacture, for E0601, Supplier Price List (PL) amount $XXX.XX

Indicate what it is, what is it for, what is Supplier Price List (PL) amount.

• Noridian Medicare website > Billing, Claims, and Appeals > Claim Submission > Claim Narrative

Q: When qualifying a patient for an E0471 (respiratory assist device with backup rate) for central sleep apnea or complex sleep apnea, do you count the mixed apnea as part of the obstructive sleep apnea (OSA) count?
A: No. When qualifying for an E0471 for central sleep apnea or complex sleep apnea, mixed apnea events are not counted as OSA events. The Local Coverage Determination (LCD) for Respiratory Assist Devices (RAD) only outlines central sleep apnea or complex sleep apnea as acceptable for qualification.

• Noridian Medicare website > Browse by Topic > Respiratory Assist Devices

Q: Is a new ABN required if there is no change in condition?
A: An ABN may remain valid when all of the following are true:

• No change in beneficiary’s condition
• No change in item or service
• No change in Medicare coverage expectations
• Same reason for expected noncoverage still applies
• ABN is properly completed and was accepted before item/service was furnished

In these situations, original ABN can remain on file and continue to be used.

• Noridian Medicare website > Browse by Topic > Advance Beneficiary Notice of Noncoverage (ABN)

Q: For oxygen reasonable useful lifetime (RUL) guidance, does the patient need a face‑to‑face (F2F) encounter within six-months prior to starting a new five‑year capped rental period? If the patient is already established, is a new written order prior to delivery (WOPD) required, and do we need a new proof of delivery (POD)?
A: When oxygen equipment reaches the end of its five‑year RUL, Medicare does not require a new F2F encounter solely because a new capped rental period is starting. However, because replacement equipment begins a new rental cycle, a new WOPD and a new POD are required, even if the beneficiary is already established.

• Noridian Medicare website > Policies > Local Coverage Determination (LCD) > Active LCDs > Standard Documentation Requirements Article

Q: Will Medicare cover both a four-wheeled walker for home rehab, and a manual wheelchair for safety if the documentation supports clinical need?
A: Both a walker and wheelchair would not be payable at the same time. Coverage criteria states for the manual wheelchair, "The beneficiary’s mobility limitation cannot be sufficiently resolved by the use of an appropriately fitted cane or walker." Therefore, if provided at the same time the claim will deny.

• Noridian Medicare website > Policies > Local Coverage Determination (LCD) > Active LCDs > Manual Wheelchair Bases

Q: Can the practitioner document why an existing L1940 (custom fabricated AFO) no longer fits to justify the beneficiary receiving a new brace?
A: Medicare may cover replacement orthotic devices when a change in the beneficiary’s condition or medical need warrants a new device. If a claim denies for same or similar, an appeal may be submitted with complete documentation supporting medical necessity for the replacement item.

• Noridian Medicare website > Browse by Topic > Repairs, Maintenance and Replacement > Replacement

Q: Are CGMs covered for beneficiaries residing in a Skilled Nursing Facility (SNF) who are not receiving skilled nursing care?
A: CGMs are not payable in a SNF once the Part A stay has ended.

• Noridian Medicare website > Billing, Claims, and Appeals > Billing Situations > Consolidated Billing

Q: When DME is delivered to a hospital or facility under the anticipation‑of‑discharge provision (up to two days prior to discharge), how should the supplier proceed if the beneficiary’s discharge is delayed beyond the two‑day window due to a change in medical condition? Is it appropriate to retrieve the equipment and re‑deliver it within two days of the revised discharge date?
A: If the discharge is delayed beyond the two‑day window, it may be appropriate to pick up the item, and re‑deliver the same item within two days of the updated, anticipated discharge date, or deliver the item on the actual date of discharge.

• Noridian Medicare website > Billing, Claims, and Appeals > Billing Situations > Consolidated Billing

Q: If a patient is receiving a 30-40 millimeter of mercury (mmHg) knee length compression garment, we cannot bill the A6531 (gradient compression stocking) for the diagnosis of I89.0 (lymphedema). What billing code do you recommend instead?
A: Noridian cannot advise on correct coding. Please reach out to the Pricing, Data Analysis, and Coding (PDAC) contractor for HCPCS/coding guidance.

Q: If a valid ABN is obtained for same or similar, do we still bill with the KX modifier? Medical necessity is met, but the quantity is the reason for denial.
A: When billing quantities that exceed utilization limits based on policy and a valid ABN is on file, the excess quantities should be billed with the GA modifier. The KX modifier is used to indicate that medical necessity requirements are met; however, when coverage is not expected and a valid ABN has been obtained, the GA modifier is appropriate. As a reminder it would not be appropriate to bill with both the KX and GA modifier on the same claim line.

• Noridian Medicare website > Browse by Topic > Advance Beneficiary Notice of Noncoverage (ABN)

Q: If an addendum is signed after the order, is a new order required? 
A: A signed addendum does not require a new standard written order (SWO) unless it adds, changes, or corrects required order elements (such as the item, quantity, frequency, or HCPCS code). Addenda may clarify existing documentation but cannot replace a required SWO or WOPD; the original encounter information must remain clear.

• Noridian Medicare website > Browse by Topic > Documentation

Q: What is required to qualify a patient with an Inspire device for oxygen therapy?
A: DME Medicare does not have any special oxygen‑therapy rules tied specifically to the Inspire device. A patient with an Inspire device must meet the same oxygen qualification criteria as any other Medicare beneficiary. The Inspire implant itself does not justify oxygen therapy. Medical records must meet the requirements outlined within the LCD for Oxygen and Oxygen Equipment for a beneficiary diagnosed with OSA before payment for oxygen can occur.

• Noridian Medicare website > Policies > Local Coverage Determination (LCD) > Active LCDs > Oxygen and Oxygen Equipment L33797

Q: Does the office visit with the ordering physician need to take place before the Complex Rehabilitation Technology (CRT) Assistive Technology Professional (ATP) assessment in every situation?
A: Based on Power Mobility Devices Policy Article A52498, the supplier’s ATP assessment must occur on or after the start of the F2F evaluation process with the treating practitioner or licensed/certified medical professional (LCMP).

• Noridian Medicare website > Policies > Local Coverage Determination (LCD) > Active LCDs > Power Mobility Devices Policy Article A52498

Q: What options do you have when a provider is not submitting appropriate monthly documentation, but the patient continues to need DME?
A: How the supplier proceeds is a business practice decision. If documentation is unavailable, an ABN may be obtained.

Q: After the 13 rental months have been billed and ownership transfers to the beneficiary, is the supplier required to send a letter, or is it sufficient to notify the beneficiary of the ownership transfer?
A: Medicare does not require the supplier to send a specific letter or separate notification at month 13 when ownership of a capped rental DME item transfers to the beneficiary.

Q: When fluorouracil is added to a sodium chloride solution for infusion, should the drug be billed under HCPCS code J9190 (Injection, fluorouracil, 500 mg) or J7999 (compounded drug, not otherwise classified)?
A: The appropriate HCPCS depends on whether or not the addition of fluorouracil to sodium chloride is considered compounding. Please refer to the PDAC, which can provide information that will assist in correct code selection.

Q: When determining eligibility for E0470 (bi‑level positive airway pressure device without a backup rate), is the sleep study data alone sufficient to rule out coverage under E0601 (continuous positive airway pressure (CPAP) device), or must the treating practitioner also document why CPAP therapy was ineffective?
A: A sleep study alone will not qualify the beneficiary for an E0470. While the sleep study can confirm OSA, the treating practitioner must also document that a PAP device was tried and found ineffective or not tolerated despite appropriate adjustments. Without clear clinical notes showing a failed or intolerable PAP trial, the E0470 would not be covered based on a sleep study alone.

• Noridian Medicare website > Policies > Local Coverage Determination (LCD) > Active LCDs > Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea

Q: For Group 2 Pressure Reducing Support Surfaces, one of the coverage criteria includes beneficiaries with “large or multiple stage 3 or 4 pressure ulcer(s) on the trunk or pelvis.” Since the term “large” is not defined in the LCD L33642 or Policy Article, is there a specific measurement that must be met to qualify as “large”? Additionally, are wound characteristics such as tunneling, undermining, or depth considered when determining if this criterion is met?
A: The determination of the size of an ulcer (e.g., "large") is typically assessed based on clinical documentation of severity, requiring comprehensive wound assessment by a healthcare provider.

Q: For oxygen therapy, when a beneficiary transitions from private insurance to Medicare, can oxygen testing performed prior to the Medicare effective date, be used to qualify for Medicare coverage? If so, what limitations or timeframes apply to the use of that testing under Medicare rules?
A: When a beneficiary transitions from private insurance to Medicare, oxygen qualifying testing performed prior to the Medicare effective date may be used if it meets Medicare requirements and was performed at the time of need. All other Medicare requirements must still be met, including a valid WOPD and supporting medical records after Medicare eligibility begins.

• Noridian Medicare website > Browse by DMEPOS Category > Oxygen

Q: If J9190 (injection, fluorouracil, 500 MG) or J7999 (compounded drug, not otherwise classified) was administered at the clinic, but the claim submitted by the pharmacy provider has a place of service (POS) 12 (home), does the POS need to be corrected to POS 11 (office)? And if so, how far back can we go to correct the claims?
A: Per Policy Article A52507, "Infusion drugs started in a practitioner’s office, whether with or without a pump, must be billed to the local carrier and not the DME MAC." If the claim was submitted with POS 12, but the drug was administered in a different setting, the POS is incorrect and must be corrected. Follow the appeals process to correct claims with an incorrect POS of 12. Appeal requests must be timely, within 120 days of the date of determination.

• Noridian Medicare website > Billing, Claims, and Appeals > Appeals

Q: When billing refill CGM supplies, which date should be used? Should we use the billed date generated by the website tool, or the date the patient actually receives the supplies?
A: You would use the date on the CGM Supply Allowance Calculator as it is a 30-day supply fee code. CGM supplies do not follow the regular refill requirements that are found in the Standard Documentation Requirements Article A55426.

• Noridian Medicare website > Policies > Local Coverage Determination (LCD) > Active LCDs > Glucose Monitors Policy Article A52464

Verbal Questions Received During ACM

Q: We have a beneficiary that has had a PAP device for five months and covered under another insurance. She now has Medicare as primary. Do we need a new proof of delivery (POD)?
A: A POD is required for all items, even those in the beneficiary's possession provided by another insurer prior to Medicare eligibility. To meet POD requirements for beneficiaries recently eligible for Medicare Fee-for-Service (FFS), with items provided by another insurer prior to FFS eligibility, the supplier record must document:

• A statement, signed and dated by the beneficiary (or beneficiary's designee), that the supplier has examined the item (date of DME item examination = date of service), meets the POD requirements; and
• A supplier attestation that the item meets Medicare requirements, including reasonable useful lifetime (RUL) requirements for item.
• Noridian Medicare website > Billing, Claims, and Appeals > Billing Situations > Beneficiaries Entering Medicare.

Q: We have a beneficiary that qualified for oxygen and a PAP device. She decided she only wanted to use the PAP device and stopped using oxygen. Her doctor has indicated she needs to be on the oxygen. How does she requalify?
A: The beneficiary needs to meet the initial qualifications of oxygen due to the break in service/need.

• Noridian Medicare website > Billing, Claims, and Appeals > Billing Situations > Break in Need and Break in Billing.

Q: One of our beneficiaries is receiving a new ankle/foot orthosis (AFO) due to a change in medical condition. We’ve been told we cannot bill the KX and GA modifiers on the same claim line. How do we bill this due to it being medically necessary but also having the ABN on file for same or similar? 
A: If the claim meets medical necessity, it is appropriate to bill with the KX modifier. The claim may deny same or similar and in the appeal request, include the ABN, the request to add the GA modifier, and the medical documentation showing the item is necessary.

Written Questions Received During ACM

Q: Can a SWO be included in a chart note or must it be a stand-alone document? For example, the chart note includes all SWO elements but is using the same signature and date for both SWO and visit note? Does this need to be separate?
A: If the treating practitioner is also the supplier the order may be listed within the medical record as long as it contains all of the required elements of the SWO. This is outlined within the Standard Documentation Requirements Article A55426.

Q: Does K0738 (rental of a home compressor used to fill portable gaseous oxygen cylinders) require a F2F and WOPD?
A: The K0738 is not listed on the Required Face-to-Face Encounter and Written Order Prior to Delivery List.

Q: If someone is set up without a WOPD and later equipment is picked up and redelivered, may the beneficiary use the same supplier, or do they need to switch suppliers? 
A: There is no rule that a different supplier is required in this instance.

Q: In the new CMS Noninvasive Positive Pressure Ventilation (NIPPV) FAQ, can you clarify what the second FAQ means as far as whether the claim is payable if the requirements end up not being satisfied for that upcoming month?
A: It means it could be payable as it is billed before the usage requirements have been met.

Q: A beneficiary was on a portable oxygen concentrator (POC), and it was picked up against medical advice (AMA) four months prior to WOPD. Now the doctor wants it re-delivered, does the doctor need to write a new WOPD?
A: If there is a 60+ days break in medical need, the beneficiary must requalify to meet the coverage criteria that is outlined for the date the item is to be delivered. A WOPD must be dated within six months of the F2F to requalify the beneficiary.

Q: Will “portable oxygen” cover the different types of portable systems (gas, POC, home fill) or does the specific type of portable system need to be listed on the WOPD?
A: Depending upon how the order is written, this may be appropriate. Per the Standard Documentation Requirements for All Claims Submitted to the DME MACs A55426, the SWO requires a general description of the item which can be “either a general description (e.g., wheelchair or hospital bed), a HCPCS code, a HCPCS code narrative, or a brand name/model number”.

Q: Does type/construction qualify for location of a stoma, as in end ileostomy is typically right lower quadrant (RLQ)?
A: The criteria states "type of ostomy, its location, its construction, and the condition of the skin surface surrounding the stoma", so stating a specific type of stoma would not support the medical necessity.

Q: Do continuous passive motion device (CPM) claims need a date span with the beginning date of date of surgery?
A: CPMs do require a date span. The first date eligible for billing is the discharge date, but the surgery date counts as day one. More information is found on our website at Billing, Claims, and Appeals > Claim Submission > Date Span Requirements on Claims.

Q: When a beneficiary needs replacement garments since they lost weight what modifier do we bill?
A: The SC modifier would be used for new garments if there has been a change in condition. An appeal may be required if the claim denies for frequency. If this should happen, send in all supporting documentation to show why new garments were needed.

Q: Is it correct in saying that a SWO for a claim under audit cannot be changed once the claim is submitted?
A: The SWO must be completed prior to claim submission. Follow directions from the auditing entity for necessary corrections. Please refer to the auditing entity for questions.

Q: We have a beneficiary who refuses to return our CPAP equipment as he already has one from another provider that is currently billing for it? Multiple attempts have been made to get our equipment back, what recourse do we have?
A: This is a business practice decision; Medicare does not have direction in these situations.

Q: Will Medicare accept an audio only telehealth visit for the F2F?
A: Telehealth visit must meet CMS telehealth requirements (42 CFR 410.78, 414.65) and the documentation must support the applicable DME policy criteria. See our website at Browse by Topic > Documentation > Telehealth for more information.

Q: When a beneficiary switches from Medicare secondary to Medicare primary, is a new SWO and POD required?
A: A new SWO and POD would not be needed if the SWO and POD on file meet all Medicare requirements.

Q: When a beneficiary transitions from Medicare Secondary Payer (MSP) to Medicare FFS primary for E0601 (CPAP) during the 13-month rental, is a F2F required after becoming primary since we have already been billing as secondary?
A: A new F2F is not required if all Medicare requirements documented in the original F2F have been met.

Q: Is Medicare now saying when the beneficiary "has" OSA, and no longer going with "suspected OSA, or OSA symptoms”?
A: Medicare requires a specific diagnosis.

Q: We issued an ABN for February 1, 2026 - April 15, 2026. Do we have to get a new one on the most current form or will it continued to be valid?
A: You do not need to obtain a new ABN solely because the form was updated. If the ABN was issued during the allowed transition period, it remains valid for the duration specified, provided there have been no changes to the treatment, condition, or coverage situation.

Q: A beneficiary has not received a CPAP unit under Medicare but had been on therapy for years prior. They had a new qualifying sleep study while under Medicare, but that is now over a year old. Is a new sleep study required, or will Medicare accept this one? If new sleep study is completed, would a new compliance be required?
A: The PAP Devices LCD L33718 outlines the requirements of beneficiaries entering Medicare. A sleep test completed prior to Medicare FFS is acceptable as long as it meets Medicare requirements, and a clinical evaluation is required after Medicare enrollment.

Q: If a prefabricated orthosis is categorized as custom fitted, but is delivered as off-the-shelf, one of the following miscellaneous codes must be used to bill the DME MAC and a narrative included on the claim. Does the narrative note need to include the description of the item? Per the Noridian tool no, however we are receiving denials requesting the description of the item.
A: If a NOC code is used for billing, a detailed narrative is required. For a NOC to process correctly, there are required elements. Details include a complete and clear description of the item. The required elements are detailed on our website under Billing, Claims, and Appeals > Billing Situations > Billing Not Otherwise Classified (NOC) HCPCS Code.

Q: Does Medicare still accept telehealth visits?
A: Telehealth visit are accepted only if they meet CMS telehealth requirements (42 CFR 410.78, 414.65) and the documentation must supports the applicable DME policy criteria.

Q: For clinical monthly notes when continued need is required and the provider is asking, what should they write? Can the DMEPOS supplier provide what is needed in the notes? If not, where in Medicare policies does it state that suppliers cannot provide this information?
A: DMEPOS suppliers may not draft or direct the provider on what should be documented in the medical record. The content of the medical records must be independently created and substantiated by the treating practitioner. Suppliers may educate providers on policy requirements. Medicare policy states that records created by suppliers or entities with a financial interest, even if signed by the provider, are not considered part of the medical record for payment purposes. More information is available on our website under Browse by Topic > Documentation > Medical Records.

Q: Per the NIPPV policy, RAD Upon Hospital Discharge section, CMS will cover in the home, a RAD with or without backup rate feature, immediately upon hospital discharge for an initial six-month period for patients with acute or chronic respiratory failure due to COPD. If the patient required either a RAD or ventilator within the 24-hour period prior to hospital discharge and the treating clinician determines that the patient is at risk of rapid symptom exacerbation or rise in PaCO2 after discharge. This policy does not mention high intensity settings so would we need high intensity setting for continued care?
A: By the end of the initial 6-month period, a RAD with backup rate feature must be utilized as high intensity therapy.

Q: Regarding the RAD LCD for CompSA > Definition of CompSA: #1 and #3 is it based on the total sleep time (TST) or the time while at the specific setting when the obstructive AHI is below 5, and while CAHI is at/above 5? For example, on bipap setting 16-12 for 20 minutes, the beneficiary has X amount of CA, OA, MA and hypopneas. Do we calculate the Obstructive AHI & CAHI based on 30 minutes or based on the TST of the whole titration study?
A: The calculation is based on the recorded sleep time.

Q: The beneficiary had a new sleep study after he became eligible for Medicare, not prior to Medicare. If the study is past one year, would it meet Medicare guidelines or would he require a new study due to being over one year old and would he require compliance?
A: A new sleep test is not required if the beneficiary was on PAP therapy prior to entering Medicare.

Sleep test - There must be documentation that the beneficiary had a sleep test, prior to FFS Medicare enrollment, that meets the Medicare AHI/RDI coverage criteria in effect at the time that the beneficiary seeks Medicare coverage of a replacement PAP device and/or accessories; and,

Clinical Evaluation - Following enrollment in FFS Medicare, the beneficiary must have an in-person evaluation by their treating practitioner who documents in the beneficiary’s medical record that: A) The beneficiary has a diagnosis of obstructive sleep apnea; and, B) The beneficiary continues to use the PAP device.

Q: If a Qualified Medicare Beneficiary (QMB) who no longer medically qualifies for a DMEPOS item, but needs service on that item, can the supplier bill the beneficiary for the cost of the repair if there is no ABN on file?
A: For QMB beneficiaries, federal law prohibits billing the beneficiary for Medicare-covered services even when Medicare denies the claim and even when no ABN is on file. An ABN would be required and a PR (patient responsibility) denial issued before billing the beneficiary for the repair.

Q: For knee orthosis coverage criteria, how is the beneficiary’s willingness determined if not documented, by the plan?
A: Willingness to participate/use the device must be supported by the treating practitioner’s medical record documentation. If it is not documented, the requirement is not met.

Q: If a DME provider receives a WOPD with E1390 (concentrator), E0431 (gas portable), and E1392 (portable oxygen concentrator), is the DME supplier able to use that WOPD for setup or does the supplier have to obtain another WOPD with only one form of portability listed before setup can be completed? Would it be acceptable to obtain a valid SWO with the specific portable option listed after setup?
A: The WOPD must list the exact items being provided to the beneficiary. If more than one portable is listed a new WOPD should be requested from the physician with the exact items being ordered.

Q: If a valid purchase option letter is not secured prior to delivery, is the supplier permitted to retrieve the power wheelchair, obtain the proper documentation, and then re-deliver it as a new power wheelchair or would the equipment need to be delivered and billed as used? Additionally, could you clarify how this situation would be handled if the missing document were an ABN?
A: Purchase option letters are no longer a document required by Medicare. ABNs must be issued prior to delivery to the beneficiary, issuing an ABN after delivery renders the ABN invalid.

Q: Can an ABN be provided when a bed is capped for QMB patients or would the ABN have to be on record prior to delivery? Is a capped bed considered a change in condition?
A: An ABN must be issued prior to delivery to the beneficiary so they are informed that Medicare may not pay. A hospital bed reaching the rental cap is not considered a change in condition.

Q: Regarding CMS Healthcare Beacon Enrollment Manager (BEM) documentation, if the beneficiary is Medicare eligible on June 1, 2025, but the testing was done on April 1, 2025, it’s within 12 months but its prior to Medicare eligible date. Is this acceptable?
A: The policy doesn’t specify a timeframe for a sleep test prior to entering Medicare.

Q: Can an oral appliance be used during a sleep study?
A: An oral appliance should not be worn during a diagnostic/initial study as it will affect the results of the test.

Q: An enteral nutrition formula beneficiary stops receiving formula through Medicare for six months due to receiving through a charity service. When the beneficiary comes back after the six months to continue receiving their formula through Medicare, are new records required for the break in billing of supplies or if the original documentation is less than 12 months old is nothing additional needed?
A: If existing documentation is timely (defined by Medicare within the preceding 12 months of the date of service), continues to support medical necessity, and there is evidence of continued need, the documentation may still be used.

Q: If a beneficiary has a prosthetic leg, is there anything preventing them from obtaining a wheelchair if all wheelchair elements are met?
A: There is nothing within the manual wheelchair LCD/PA that would disqualify a beneficiary from receiving a wheelchair based on a prosthetic leg. The beneficiary would need to meet the coverage criteria of the LCD/PA for the wheelchair.

Q: We have a bipap and oxygen bleed-in order for a beneficiary that had an oral device with both the treatment (TX) and diagnosis (DX). Can we use that to qualify the oxygen?
A: We cannot pre-approve claims. The medical record would need to show the OSA was treated prior to qualifying for oxygen.

Q: How can we tell when Medicare FFS became active if a beneficiary is Part B eligible before they enrolled in FFS?
A: Suppliers can utilize the Noridian Medicare Portal to check eligibility.

Q: Is a WOPD for oxygen setup valid for 30 days or 90 days before setup?
A: The WOPD needs to be completed within six months of the face-to-face.

Q: Are DMEPOS suppliers responsible for repairs if the equipment is capped and in the RUL stage?
A: Suppliers are required to ensure the item continues to work for the RUL of the item provided. See our website under Browse by Topic > Repairs, Maintenance and Replacement > Repairs for more information.

Q: If a beneficiary has a permanent tracheostomy, diagnosed with OSA, and is requiring oxygen nocturnal only, does the tracheostomy negate the OSA guidelines? And then following the OSA guidelines that the oxygen testing used to qualify for nocturnal use, it must be completed in a facility-based sleep lab, correct?
A: The OSA must still be optimally treated in order to qualify for the oxygen. The Oxygen LCD states for beneficiaries with OSA titration polysomnographic study (either split night or stand-alone) is required.

Q: Lymphedema rules say they can have a quantity of three daytime garments or wraps per body part every six months. Do they have to receive all on the same claim? Can they get two this month and another in two months as long as we do not provide more than three in a six-month period?
A: You can bill on separate days as long as it doesn't exceed three per six months.

Q: How will a beneficiary on an Inspire need to be qualified for oxygen? Will they need to have a titration while on the Inspire?
A: The OSA must be sufficiently treated such that the underlying condition resulting in hypoxemia is unmasked.