The Centers for Medicare & Medicaid Services (CMS) added a statement to the “Standard Documentation Requirements for All Claims Submitted to DME MACs” article to clarify that a face-to-face patient encounter is not required when a beneficiary is receiving replacement of a device with the same Healthcare Common Procedure Coding System (HCPCS) code at the end of its expected reasonable useful life (RUL). The clarification has a retroactive effective date of January 1, 2024.
The document, with the new sentence added, now reads, “A qualifying face-to-face encounter is required each time a new order/prescription for one of the specified items on the Required List is ordered. The exception to this requirement is for items replaced with an identical item (same HCPCS code) following the expiration of the five-year RUL.”
To review the article and revision history number R26,visit the CMS website.
