Detailed Written Orders
Medicare requires an order for every item (except repairs) of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Detailed written orders are used to confirm what was ordered by the treating physician following the supplier's receipt of a verbal or written dispensing order. Detailed written orders must include separately billable options, accessories or supplies related to the base item that is ordered. Detailed written orders must not be used to add unrelated items, whether requested by the beneficiary or not, in the absence of a dispensing order from the physician for that item.
Example: The treating physician calls the supplier and prescribes a glucose monitor with a verbal order. The supplier can then create a detailed written order that includes an itemized listing of all directly related, separately billable items - i.e., the glucose monitor, test strips, lancets, calibration solution, batteries and lancing device. This detailed written order is then returned to the physician for their signature.
Although the initial dispensing order from the physician did not specifically include the test strips, lancets, and other supplies, they are clearly related to the glucose monitor. Therefore, it is an acceptable detailed written order. For detailed written orders of this type, no further action is required from the physician beyond their signature and date. However, for other type of detailed written orders other actions by the physician may be required. (See below)
In the example above, it is not acceptable for the supplier to include additional, unprescribed and unrelated items, such as a vacuum erection device, water circulating heating pad or wrist orthosis to the detailed written order. While the test strips, lancets, and other supplies are related to the glucose monitor in the original order, the vacuum erection device, water circulating heating pad and wrist orthosis cannot and therefore must not be included on the detailed written order.
Some suppliers use preprinted forms for their detailed written orders that include a listing of many different items, not all of which may be needed by an individual beneficiary. These listings often create incompatible combinations. For example, an order form for CPAP accessories might list all possible interfaces. On these forms, the final document that is signed and dated by the physician must clearly identify the specific items that are being ordered for that patient. This may be accomplished in one of two ways:
- The supplier may indicate the items that are being provided before sending the form to the physician. The physician can then review the form and accept either the items marked by the supplier or, make any necessary changes. The physician must then initial and date the revised entries; or,
- The supplier may send the form to the physician without any items selected and ask the physician to indicate which items are being ordered. The physician must make their choice clear. Check marks, circling items or other affirmative indicators are acceptable ways to show that the physician selected the item(s).
In each case, the physician must sign and date the form.
The following are examples (not all-inclusive) of forms listing multiple items, which would be considered invalid detailed written orders:
- Forms listing incompatible items without specific items being selected. For example, for CPAP, a form which includes full-face mask, nasal mask, and nasal pillows with none being specifically selected by the physician.
- Forms in which incompatible items are checked off or selected, by either the supplier or the physician. For example, a form which includes full-face mask, nasal mask, and nasal pillows and two or all three are selected.
Refer to the Supplier Manual and the LCDs for additional information about order requirements.
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