For Medicare to cover any Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) item, the patient’s medical record must include enough documentation to justify the need for the type and quantity of items ordered and frequency of use (or replacement if applicable). The medical record should include the patient’s diagnosis and:

• Condition duration
• Clinical course (worsening or improving)
• Prognosis
• Nature and extent of functional limits
• Other therapeutic interventions and results
• Experience with related items

The medical record may include records from hospitals, nursing facilities, home health agencies, and other health care professionals.

For more information, see the Medicare Program Integrity Manual, Chapter 5 (PDF), section 5.9.

Source: CMS MLN Connects dated January 13, 2022