DME MACs Retire Dear Physician Letter

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The Durable Medical Equipment Medical Administrative Contractors (DME MACs) have retired the Dear Physician letter for artificial limbs that has been in place since 2011 and that led to an increase in claim denials and related appeals. Prior to the letter, O&P practitioners' notes were accepted as part of the medical file for claim-related decisions. In February, passage of a legislative Continuing Resolution made clinical notes from orthotists and prosthetists again acceptable as part of patients' medical records, making the wording of the Dear Physician letter inconsistent with the law.

The revision posted by the DME MACs reads as follows:

"On February 8, 2018, the U.S. Congress amended Section 1834(h) of the Social Security Act (42 U.S.C. 1395m(h)), adding a new paragraph:

(5) DOCUMENTATION CREATED BY ORTHOTISTS AND PROSTHETISTS. – For purposes of determining the reasonableness and medical necessity of orthotics and prosthetics, documentation created by an orthotist or prosthetist shall be considered part of the individual's medical record to support documentation created by eligible professionals described in section 1848(k)(3)(B).

The Centers for Medicare & Medicaid Services (CMS) is in the process of considering any program changes that may be necessary as a result of this legislation. Thus, this article is being retired pending instructions from CMS."