Public Health Emergency Impact Summary
Public Health Emergency Impact Summary
Background: CMS announced that during the Public Health Emergency (PHE) it would not enforce certain clinical indications for coverage and face-to-face requirements specified in National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) for certain items of Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS). This policy was announced via interim final rules with comment (IFCs) CMS-1744 (PDF) and CMS-5531 (PDF), to allow for maximum flexibility for practitioners to care for their patients during the PHE. The PHE ended on May 11, 2023. The information below is responsive to provider/supplier inquiries, and outlines when such flexibilities would be applicable. This document details CMS’ expectations related to initial coverage and subsequent continuing coverage (e.g., oxygen recertification, CGM continued in-person visits) requirements applicability both during and after the PHE.
Durable Medical Equipment (DME) Items initially ordered before PHE (March 1, 2020 - May 11, 2023) and subject to PHE flexibilities:
| Initial documentation impacted? | No – Contractors will follow the NCD/LCD to audit documentation from when the item is rendered |
| Intra-PHE continuing requirements? | If the continuing coverage requirements occurred during the PHE, follow the flexibilities outlined in CMS-1744 and CMS-5531* |
| Post PHE continuing requirements? | If the continuing coverage requirements occurred prior to or after the PHE, follow the NCD/LCD** |
Durable Medical Equipment (DME) Items ordered during PHE (March 1, 2020 - May 11, 2023) and subject to PHE flexibilities:
| Initial documentation impacted? | Yes- follow the flexibilities outlined in CMS-1744 and CMS-5531 |
| Intra-PHE continuing requirements? | If the continuing coverage requirements occurred during the PHE, follow the flexibilities outlined in CMS-1744 and CMS-5531* |
| Post PHE continuing requirements? | If the continuing coverage requirements occurred after the PHE, follow the NCD/LCD** |
Durable Medical Equipment (DME) Items ordered after the PHE ended (May 11, 2023):
| Documentation impacted? | No – Contractors will follow the NCD/LCD to audit documentation from when the item is rendered |
*The IFCs only provided flexibilities for DMEPOS clinical indications for coverage and face-to-face requirements specified in CMS National & Local Coverage Determinations; it did not provide such flexibilities for statutes or regulations. Therefore, the statutory requirement to recertify some beneficiaries for oxygen remained in effect.
**Separately, we note that for Continuous Glucose Monitors the practitioners are expected to see their patients every six months. For administrative simplicity, we have clarified that practitioners must see their patients within 6 months of the expiration of the PHE.
Page Last Modified:
09/10/2024 06:18 PM