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Updates from CGS Medicare on Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) for Suppliers Located in NC, SC, VA and WV


CGS Medicare understands the challenges that everyone is experiencing during the COVID-19 public health emergency. CMS has made several changes to assist treating practitioners and DMEPOS suppliers in getting equipment and supplies to beneficiaries during this period. The changes were created to minimize the beneficiary’s chances for exposure to COVID-19. Documentation to support the need for any item must be substantiated in the beneficiary’s medical record.

CGS continues to collaborate with Palmetto GBA to provide education for physicians and practitioners through webinars, articles and teleconferences. CGS and Palmetto GBA offers this education for treating practitioners to ensure they are up-to-date on the documentation requirements for the prescribed equipment and supplies. This helps suppliers dispense items to the Medicare beneficiary in a timely manner.

Below are some of the errors CGS continues to see and receive questions about in our call center. The DMEPOS supplier may reach out to the treating practitioner for additional information to support the necessity for these type denials.

  • Same or similar item in use by the beneficiary
  • Medical necessity denial for the number of units billed
  • The medical necessity for the item not established
  • Orders incomplete or missing

What’s New
CGS has a dedicated webpage for information on COVID-19. This page contains guidance for DMEPOS suppliers on how CGS will handle certain requirements. Suppliers can find information on modifier usage, waivers, ABNs, prior authorization, proof of delivery, FAQ and much more. CGS revises this page as new and updated information is received from CMS. Suppliers can find additional information on the CGS website at
Find DMEPOS COVID-19 Information here.

Self-Service Guide
This guide is a convenient source for information about all the self-service tools and calculators available to suppliers for easy reference. The tools included in the reference guide are the same ones available on the CGS website under Online Tools & Calculators, but in an easy-to-use PDF version.
Self-Service Guide — NEW!

Mobile App
The CGS Medicare Mobile App has been updated with more features including LCDs, Dear Physician Letters, CGS Wizard access and more. The CGS Medicare Mobile App is available in the App Store or Google Play Store. Simply search CGS Medicare to download this free app. For additional information on this app, click this link
CGS Medicare for FAQ and CGS Medicare App Guide.

Therapeutic Shoes for Persons with Diabetes Activity Timeline (PDF, 90 KB)
CGS designed this PDF timeline to assist suppliers in obtaining the proper documentation from the certifying physician and ordering physician or practitioner and the timeframe required. This timeline is based on the requirements outlined in the LCD and Policy Article.

Orthotics Chart
The
Orthotics Chart (PDF, 170 KB) was designed to show the differences between off-the-shelf, custom-fit, and custom-fabricated items. The chart offers a side-by-side comparison of the requirements. It also includes links to the Policy Article and the DMEPOS Quality Standards if additional information is needed.  

myCGS
Suppliers now able to submit reopening and redetermination requests through the myCGS web portal on the CGS website. This secure web portal allows suppliers to also check the status of submitted requests. This is just one of the many features available in myCGS that suppliers have access to for fast and easy claim and billing assistance. Visit the
myCGS web portal for details.

Physician’s Corner
As a reminder, the
Physician's Corner is specifically designed as a dedicated page for physicians and practitioners who prescribe DMEPOS items to Medicare beneficiaries. This page includes sections with important physician-based information that provides details and clarification on documentation requirements and why they are needed. Treating practitioners can find information on topics such as: Dear Physician Letters, Documentation Checklists and articles that provide direction for specific items ordered by physicians and much more.

Documentation Requirements
A Standard Written Order (SWO) is required for all items billed to Medicare. It replaces all previous versions of orders including: the dispensing or preliminary order, Detailed Written Order (DWO), Five Element Order (5EO), Seven Element Order (7EO), and the Detailed Product Description (DPD). Some items require the SWO prior to delivery. Information on the types of orders needed and other documentation requirements can be found in the
Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426).

If you have ideas or suggestions on how CGS can improve on the types of education we provide on DMEPOS items and the documentation needed, please contact us using the following:

Can be found on the cgsmedicare.com/jc home page. Scroll to the bottom of the page and the link to the website feedback is listed under Site Info.

Please respond quickly and completely to requests for documentation from the DMEPOS supplier. This helps the supplier to continue to provide services ordered for your Medicare beneficiary.


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Last Updated: 09/01/2020