Waiver/Flexibility

Summary

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

When DMEPOS is lost, destroyed, irreparably damaged, or otherwise rendered unusable, allows the DME Medicare Administrative Contractors (MACs) to have the flexibility to waive replacement requirements such that the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required.  Suppliers must still include a narrative description on the claim explaining the reason why the equipment.  Suppliers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the item was lost, destroyed, irreparably damaged, or otherwise rendered unusable or unavailable as a result of the emergency.

Clinical Indications for Certain Respiratory, Home Anticoagulation Management, Infusion Pump, and Therapeutic Continuous Glucose Monitor (CGM) national and local coverage determinations

In the interim final rule with comment period (CMS-1744-IFC and CMS-5531-IFC) CMS states that clinical indications of certain national and local coverage determinations will not be enforced during the COVID-19 public health emergency.  CMS will not enforce clinical indications for respiratory, oxygen, infusion pump and continuous glucose monitor national coverage determinations and local coverage determinations.

Face-to-face and In-person Requirements for national and local coverage determinations

In the interim final rule with comment period (CMS-1744-IFC) CMS states that to the extent a national or local coverage determination would otherwise require a face-to-face or in-person encounter for evaluations, assessments, certifications or other implied face-to-face services, those requirements would not apply during the COVID-19 public health emergency.

Requirement for DMEPOS Prior Authorization

The requirement to submit a prior authorization request for certain DMEPOS items and services was paused.  Suppliers were given the option to voluntarily continue submitting prior authorization requests or to skip prior authorization and have the claim reviewed through post payment review at a later date.  Claims that would normally require prior authorization, but were submitted without going through the process should be submitted with the CR Modifier.

Waiver/Flexibility

Summary

Signature requirements for proof of delivery

The signature requirement for Part B drugs and certain Durable Medical Equipment (DME) that require a proof of delivery and/or a beneficiary signature was waived.  Providers should use a CR modifier on the claim and document in the medical record the appropriate delivery date and that the signature could not be obtained because of COVID-19.

Waiver/Flexibility

Summary

Replacement Prescription Fills

Medicare payment may be permitted for replacement prescription fills (for a quantity up to the amount originally dispensed) of covered Part B drugs in circumstances where dispensed medication has been lost or otherwise rendered unusable by damage due to the disaster or emergency.

Part B Prescription Drug Refills

MACs may exercise flexibilities regarding the payment of Medicare Part B claims for drug quantities that exceed usual supply limits, and to permit payment for larger quantities of drugs, if necessary.  MACs may require the use of the CR modifier in these cases.