ACA: Face-to-Face and Detailed Written Order - JD DME
ACA: Face-to-Face and Detailed Written Order
The Standard Written Order (SWO) requirements are in effect for dates of service January 1, 2020 and after.
Refer to the SWO page for the elements needed in this streamlined order.
Continue to use the instructions below for dates of service prior to January 1, 2020.
Applicable for Dates of Service Prior to January 1, 2020.
42 CFR 410.38(g) contains provisions that are applicable to certain specified DMEPOS items. CMS provides a list of the specified items, which is periodically updated, and located on the CMS website.
These items require an in-person, face-to-face interaction between the beneficiary and their treating physician/practitioner prior to prescribing the item. This face-to-face requirement includes examinations conducted via the CMS-approved use of telehealth examinations (as described in the CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 and CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 12).
This face-to-face evaluation must specifically document that the beneficiary was evaluated and/or treated for a condition that supports the need for the DME item(s) ordered. A dispensing order is not sufficient to provide these items. A 5EO must be received prior to delivery. Refer to the applicable LCD-related Policy Article NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES section for information about these statutory requirements.
Documentation Types
- ACA Face-to-Face - A practitioner (MD, DO, DPM, PA, NP, CNS) has had a F2F examination with a beneficiary within the six (6) months prior to the written order for certain DME items.
- ACA 5EO - For some items to be covered by Medicare, a written order is required to be in the supplier's file prior to delivery of the specified item(s).
ACA Items
This list is subject to CMS annual review and may change as necessary.
HCPCS Code | Description |
---|---|
E0185 | Gel or gel-like pressure mattress pad |
E0188 | Synthetic sheepskin pad |
E0189 | Lamb's wool sheepskin pad |
E0194 | Air fluidized bed |
E0197 | Air pressure pad for mattress standard length and width |
E0198 | Water pressure pad for mattress standard length and width |
E0199 | Dry pressure pad for mattress standard length and width |
E0250 | Hospital bed fixed height with any type side rails, mattress |
E0251 | Hospital bed fixed height with any type side tails without mattress |
E0255 | Hospital bed variable height with any type side rails with mattress |
E0256 | Hospital bed variable height with any type side rails without mattress |
E0260 | Hospital bed semi-electric (Head and foot adjustment) with any type side rails with mattress |
E0261 | Hospital bed semi-electric (head and foot adjustment ) with any type side rails without mattress |
E0265 | Hospital bed total electric (head, foot and height adjustments) with any type side rails with mattress |
E0266 | Hospital bed total electric (head, foot and height adjustments) with any type side rails without mattress |
E0290 | Hospital bed fixed height without rails with mattress |
E0291 | Hospital bed fixed height without rails without mattress |
E0292 | Hospital bed variable height without rail without mattress |
E0293 | Hospital bed variable height without rail with mattress |
E0294 | Hospital bed semi-electric (head and foot adjustments) without rail with mattress |
E0295 | Hospital bed semi-electric (head and foot adjustments) without rail without mattress |
E0296 | Hospital bed total electric (head, foot and height adjustments) without rail with mattress |
E0297 | Hospital bed total electric (head, foot and height adjustments) without rail without mattress |
E0300 | Pediatric crib, hospital grade, fully enclosed |
E0301 | Hospital bed Heavy Duty extra wide, with weight capacity 350-600 lbs with any type of rail, without mattress |
E0302 | Hospital bed, Heavy Duty extra wide, with weight capacity greater than 600 lbs with any type of tail, without mattress |
E0303 | Hospital bed Heavy Duty extra wide, with weight capacity 350-600 lbs with any type of rail, with mattress |
E0304 | Hospital bed heavy Duty extra wide, with weight capacity greater than 600 lbs with any type of rail, with mattress |
E0424 | Stationary compressed gas Oxygen System rental: includes contents, regulator, nebulizer, cannula or mask and tubing |
E0431 | Portable gaseous oxygen system rental includes portable container, regulator, flowmeter, humidifier, cannula or mask, an tubing |
E0433 | Portable liquid oxygen system |
E0434 | Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, content gauge, cannula or mask, and tubing |
E0439 | Stationary liquid oxygen system rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
E0441 | Oxygen contents, gaseous (1 months supply) |
E0442 | Oxygen contents, liquid (1 months supply) |
E0443 | Portable Oxygen contents, gas (1 months supply) |
E0444 | Portable oxygen contents, liquid (1 months supply) |
E0450 | Volume control ventilator without pressure support used with invasive interface |
E0460 | Negative pressure ventilator portable or stationary |
E0461 | Volume control ventilator without pressure support node for a noninvasive interface |
E0462 | Rocking bed with or without side rail |
E0463 | Pressure support ventilator with volume control mode used for invasive surfaces |
E0464 | Pressure support vent with volume control mode used for noninvasive surfaces |
E0470 | Respiratory Assist Device, bi-level pressure capability, without backup rate used non-invasive interface |
E0471 | Respiratory Assist Device, bi-level pressure capability, with backup rate for non-invasive interface |
E0472 | Respiratory Assist Device, bi-level pressure capability, with backup rate for invasive interface |
E0480 | Percussor electric/pneumatic home model |
E0482 | Cough stimulating device, alternating positive and negative airway pressure |
E0483 | High Frequency chest wall oscillation air pulse generator system |
E0484 | Oscillatory positive expiratory device, non-electric |
E0570 | Nebulizer with compressor |
E0575 | Nebulizer, ultrasonic, large volume |
E0580 | Nebulizer, durable, glass or autoclavable plastic, bottle type for use with regulator or flowmeter |
E0585 | Nebulizer with compressor & heater |
E0601 | Continuous airway pressure device |
E0607 | Home blood glucose monitor |
E0627 | Seat lift mechanism incorporated lift-chair |
E0628 | Separate Seat lift mechanism for patient owned furniture electric |
E0629 | Separate seat lift mechanism for patient owned furniture non-electric |
E0636 | Multi positional patient support system, with integrated lift, patient accessible controls |
E0650 | Pneumatic compressor non-segmental home mode |
E0651 | Pneumatic compressor segmental home model without calibrated gradient pressure |
E0652 | Pneumatic compressor segmental home model with calibrated gradient pressure |
E0655 | Non-segmental pneumatic appliance for use with pneumatic compressor on half arm |
E0656 | Non-segmental pneumatic appliance for use with pneumatic compressor on trunk |
E0657 | Non-segmental pneumatic appliance for use with pneumatic compressor on chest |
E0660 | Non-segmental pneumatic appliance for use with pneumatic compressor on full leg |
E0665 | Non-segmental pneumatic appliance for use with pneumatic compressor on full arm |
E0666 | Non-segmental pneumatic appliance for use with pneumatic compressor on half leg |
E0667 | Segmental pneumatic appliance for use with pneumatic compressor on full leg |
E0668 | Segmental pneumatic appliance for use with pneumatic compressor on full arm |
E0669 | Segmental pneumatic appliance for use with pneumatic compressor on half leg |
E0671 | Segmental gradient pressure pneumatic appliance full leg |
E0672 | Segmental gradient pressure pneumatic appliance full arm |
E0673 | Segmental gradient pressure pneumatic appliance half leg |
E0675 | Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency |
E0692 | Ultraviolet light therapy system panel treatment 4 foot panel |
E0693 | Ultraviolet light therapy system panel treatment 6 foot panel |
E0694 | Ultraviolet multidirectional light therapy system in 6 foot cabinet |
E0720 | Transcutaneous electrical nerve stimulation, two lead, local stimulation |
E0730 | Transcutaneous electrical nerve stimulation, four or more leads, for multiple nerve stimulation |
E0731 | Form fitting conductive garment for delivery of TENS or NMES |
E0740 | Incontinence treatment system, Pelvic floor stimulator, monitor, sensor and/or trainer |
E0744 | Neuromuscular stimulator for scoliosis |
E0745 | Neuromuscular stimulator electric shock unit |
E0747 | Osteogenesis stimulator, electrical, non-invasive, other than spine application |
E0748 | Osteogenesis stimulator, electrical, non-invasive, spinal application |
E0749 | Osteogenesis stimulator, electrical, surgically implanted |
E0760 | Osteogenesis stimulator, low intensity ultrasound, non-invasive |
E0762 | Transcutaneous electrical joint stimulation system including all accessories |
E0764 | Functional neuromuscular stimulator, transcutaneous stimulations of muscles of ambulation with computer controls |
E0765 | FDA approved nerve stimulator for treatment of nausea & vomiting |
E0782 | Infusion pumps, implantable, non-programmable |
E0783 | Infusion pump, implantable, programmable |
E0784 | External ambulatory infusion pump |
E0786 | Implantable programmable infusion pump, replacement |
E0840 | Tract frame attach to headboard, cervical traction |
E0849 | Traction equipment cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible |
E0850 | Traction stand, free standing, cervical traction |
E0855 | Cervical traction equipment not requiring addition stand or frame |
E0856 | Cervical traction device, cervical collar with inflatable air bladder |
E0958 | Manual wheelchair accessory, one-arm drive attachment |
E0959 | Manual wheelchair accessory, adapter for amputee |
E0960 | Manual wheelchair accessory, shoulder harness/strap |
E0961 | Manual wheelchair accessory wheel lock brake extension handle |
E0966 | Manual wheelchair accessory, headrest extension |
E0967 | Manual wheelchair accessory, hand rim with projections |
E0968 | Commode sear, wheelchair |
E0969 | Narrowing device wheelchair |
E0971 | Manual wheelchair accessory anti-tipping device |
E0973 | Manual wheelchair accessory, adjustable height, detachable armrest |
E0974 | Manual wheelchair accessory anti-rollback device |
E0978 | Manual wheelchair accessory positioning belt/safety belt/pelvic strap |
E0980 | Manual wheelchair accessory safety vest |
E0981 | Manual wheelchair accessory seat upholstery, replacement only |
E0982 | Manual wheelchair accessory, back upholstery, replacement only |
E0983 | Manual wheelchair accessory power add on to convert manual wheelchair to motorized wheelchair, joystick control |
E0984 | Manual wheelchair accessory power add on to convert manual wheelchair to motorized wheelchair, tiller control |
E0985 | Wheelchair accessory, seat lift mechanism |
E0986 | Manual wheelchair accessory, push activated power assist |
E0990 | Manual wheelchair accessory, elevating leg rest |
E0992 | Manual wheelchair accessory, solid seat insert |
E0994 | Arm rest |
E1014 | Reclining back, addition to pediatric size wheelchair |
E1015 | Shock absorber for manual wheelchair |
E1020 | Residual limb support system for wheelchair |
E1028 | Wheelchair accessory, manual swing away, retractable or removable mounting hardware for joystick, other control interface or positioning accessory |
E1029 | Wheelchair accessory, ventilator tray |
E1030 | Wheelchair accessory, ventilator tray, gimbaled |
E1031 | Rollabout chair, any and all types with castors 5" or greater |
E1035 | Multi-positional patient transfer system with integrated seat operated by care giver |
E1036 | Patient transfer system |
E1037 | Transport chair, pediatric size |
E1038 | Transport chair, adult size up to 300lb |
E1039 | Transport chair, adult size heavy duty >300lb |
E1161 | Manual adult size wheelchair includes tilt in space |
E1227 | Special height arm for wheelchair |
E1228 | Special back height for wheelchair |
E1232 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable with seating system |
E1233 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable without seating system |
E1234 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable without seating system |
E1235 | Wheelchair, pediatric size, rigid, adjustable, with seating system |
E1236 | Wheelchair, pediatric size, folding, adjustable, with seating system |
E1237 | Wheelchair, pediatric size, rigid, adjustable, without searing system |
E1238 | Wheelchair, pediatric size, folding, adjustable, without searing system |
E1296 | Special sized wheelchair seat height |
E1297 | Special sized wheelchair seat depth by upholstery |
E1298 | Special sized wheelchair seat depth and/or width by construction |
E1310 | Whirlpool non-portable |
E2502 | Speech generating devices prerecord messages between 8 and 20 minutes |
E2506 | Speech generating devices prerecord messages over 40 minutes |
E2508 | Speech generating devices message through spelling, manual type |
E2510 | Speech generating devices synthesized with multiple message methods |
E2227 | Rigid pediatric wheelchair adjustable |
K0001 | Standard wheelchair |
K0002 | Standard hemi (low seat) wheelchair |
K0003 | Light weight wheelchair |
K0004 | High strength ltwt wheelchair |
K0005 | Ultra lightweight wheelchair |
K0006 | Heavy duty wheelchair |
K0007 | Extra heavy duty wheelchair |
K0009 | Other manual wheelchair/base |
K0606 | AED garment with electronic analysis |
K0730 | Controlled dose inhalation drug delivery system |
Resources
- ACA Face-to-Face Requirements and CERT Enforcement
- CMS Face-to-Face Encounter Requirement for Certain Durable Medical Equipment
- CMS IOM, Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.5
- CMS Medicare Learning Network (MLN) Matters (MM)8304
Last Updated Mon, 08 Mar 2021 15:29:47 +0000
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