DMEPOS General Documentation Requirements

Documentation requirements apply to certain DMEPOS items.

All claims billed to Medicare require a written order or prescription from the treating practitioner as a condition for payment, which must meet standard written order (SWO) requirements.

To justify payment, suppliers must meet these requirements:

• SWO
• Medical record information (including continued need and use if applicable)
• Correct coding
• Proof of delivery (POD)

The treating practitioner must communicate an SWO to the supplier before submitting a claim. For certain DMEPOS items, we require a written order prior to delivery before the you deliver the items to the patient.

An SWO must have:

• The patient’s name or MBI
• The order date
• A general item description. This can be a general description (for example, a wheelchair or hospital bed), a HCPCS code, a HCPCS code narrative, or a brand name or model number.
  • For equipment: Besides the description of a base item, the SWO may include all concurrently ordered options, accessories, or other features that are separately billed or require an upgraded code (list each separately)
  • For supplies: Besides the description of a base item, the SWO may include all concurrently ordered supplies that are separately billed (list each separately)
• The dispensed quantity, if applicable. Prescriptions may be refillable
• The treating practitioner’s name or NPI and signature

Signature and date stamps aren’t allowed, with a few exceptions. Follow the signature requirements in the Medicare Program Integrity Manual, Chapter 3 (PDF), section 3.3.2.4.

The Complying with Medical Record Documentation Requirements (PDF) and Complying with Medicare Signature Requirements (PDF) have more guidance.