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DME: CMS Face-to-Face Requirement

MCN Question of the Week

DME: CMS Face-to-Face Requirement


Is there any update on when CMS will begin to require compliance with the face-to-face requirement for DME patients?


The latest update from CMS regarding the face-to-face encounter requirement for certain durable medical equipment was posted on September 9, 2015.  The update stated that CMS will not start actively enforcing or expect full compliance with the DME face-to-face requirements until further notice.

The delay of enforcement only applies to the face-to-face requirements in CFR §410.38(g)(3). CMS expects full compliance with the remaining portions of the regulation. The DME Medicare Administrative Contractors (MACs) began enforcing the detailed written order requirement as of January 1, 2014.


On November 16, 2012 CMS issued a final rule titled “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013”.  This final rule was written to implement the statutory provision at Section 1834(a)(11)(B) of the Social Security Act that established requirements for a face-to-face encounter and written orders prior to delivery for certain items of DME.

CMS developed a list of DME items subject to the face-to-face encounter requirements created by the rule.

The law originally required a physician to document that a physician, nurse practitioner, physician assistant or clinical nurse specialist had a face-to-face encounter with the patient. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the requirement for physicians to document face-to-face encounters conducted by allowed nurse practitioners, physician assistants, or clinical nurse specialists.  As revised by MACRA, a physician, nurse practitioner, physician assistant or clinical nurse specialist must document they have written the order for DME pursuant to a face-to-face encounter with the patient. The encounter must occur within the 6 months before the order is written for the DME.

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Durable & Home Medical Equipment Compliance Manual



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