Physician Equipment Criteria
F2F is required for:
- Pressure Reducing Support Surfaces (Mattress overlay, mattress, powered or non-powered pressure reducing mattress)
- Hospital beds
- Home blood glucose monitors
- Seat Lift chairs
- Pneumatic appliances/gradient pressure appliances (Lymphedema pumps)
- Rollabout chair
- Diabetic (Therapeutic) shoes
- Power mobility device(PMD)/power wheelchair
- The date of the F2F must be on or before the date of the written order (prescription) and may be no older than 6 months prior to the prescription date.
- The F2F encounter conducted by the physician, PA, NP, Clinical Nurse Specialist must document that the beneficiary was evaluated and/or treated for a condition that supports the item(s) of DME ordered
- The physician must document the occurrence of the F2F encounter by signing/co-signing and dating the pertinent portion of the medical record.
The treating practitioner that conducted the F2F exam does not need to be the prescriber for the DME item. However the prescriber must:
Verify that the in-person visit occurred within the 6-months prior to the date of their prescription, and have documentation of the F2F examination that was conducted.
The prescriber must provide a copy of the F2F examination and the prescription for the item(s) to the DMEPOS supplier before the item can be delivered.
*ALL DMEPOS suppliers must have documentation of both the F2F visit and the completed written order prior to delivery (WOPD) in their file prior to the delivery of items.
PHYSICIAN ORDER’S/STATEMENT OF MEDICAL NECESSITY – GENERAL GUIDELINES
- Beneficiary’s name
- Physician’s name
- Date of the order and the start date, if the start date is different from the date of the order
- Diagnosis(es) OR ICD-9 code(s)
- Detailed description of the item(s)/option(s)/accessory(ies) to be ordered/dispensed. I.E.-FWW with seat, semi-electric hospital bed, nebulizer
- Length of need –EXCEPTION - walkers
- Treating physician’s signature, NPI, and signature date
Click the links below to view criteria for each equipment category: