The Medical Directors for all 4 DME Medicare Administrative Contractors (MACs) have developed “Dear Physician” letters to help define medical necessity requirements of specific items such as diabetic supplies, oxygen equipment, power wheelchairs and power operated devices, hospital beds, therapeutic shoes for diabetics, nebulizers, etc., for ordering physicians. If the treatment plan includes durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), Medicare requires that suppliers have access to information from the patient’s medical record that addresses the coverage criteria for the items prescribed. Utilization of these “Dear Physician” letters will ensure the required information and documentation are available. Suppliers are expected to furnish the DME MAC, CERT contractor, Recovery Auditor (RA) and Zone Program Integrity Contractor (ZPIC) with medical record documentation to support the medical necessity of the items they furnish, when requested. To view the letters, click
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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.