DME MACs, AOPA Clarify Device Replacement Waivers

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On March 18, the Centers for Medicare & Medicaid Services (CMS)  announced it was permitting waivers regarding replacement of durable  medical equipment prosthetics, orthotics, and supplies (DMEPOS) to help Medicare beneficiaries impacted by the COVID-19 outbreak and quarantines receive prompt care. CMS issued the following guidance: "Where [DMEPOS]  is lost, destroyed, irreparably damaged, or otherwise rendered unusable or
unavailable, contractors have the flexibility to waive replacements requirements such that the face-to-face requirement, a new physician's order, and new medical necessity documentation."

The American Orthotic and Prosthetic Association (AOPA), in response to questions and concerns from its members about the policy, contacted the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) about implementation of provisions of these emergency-based waivers.

According to AOPA, the DME MACs stated that the 1135 waivers only apply to replacements that are necessary as a "direct result of the emergency." The example given was that if a patient were transported to the hospital with
COVID-19 symptoms and his or her device was lost in the ambulance, the replacement waiver would apply. A beneficiary's inability to make an appointment or see the referring physician does not qualify under the current provisions of the waivers. AOPA also noted that the waivers don't apply to new services such as socket replacements.

 

For more information about the waiver policy, visit the CMS document Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19).