https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
Question: During the public health emergency (PHE) for the COVID-19 pandemic, does the requirement for a face-to-face examination apply for power mobility devices?
Answer: Yes. Power mobility devices continue to require face-to-face examination and a written prescription for the item, as mandated by statute and regulation (section 1834(a)(1)(E))(iv) of the Act and 42 C.F.R. § 410.38). The face-to-face encounter may be conducted via telehealth.
Question: CMS-1744-IFC (April 6, 2020) established that CMS will not enforce certain requirements for face-to-face or in-person encounters for evaluations, assessments, and certifications, that would otherwise apply through NCDs, LCDs, or articles during the PHE. Does this mean that documentation indicating that a beneficiary meets coverage criteria for the DMEPOS is not necessary? What are the requirements for physician or non-physician signatures?
Answer: No, these requirements are still required during the PHE. We remind physicians, practitioners, and suppliers that services and equipment furnished to patients must be reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act. Accordingly, the medical record should be sufficient to demonstrate that payment for the services billed is warranted (that is, the services were actually provided, were provided at the level billed, and were medically necessary). Power Mobility Devices (PMDs) require a written order prior to delivery. Other DMEPOS require written orders with a practitioner signature before the claim is submitted for payment (42 CFR 410.38(d)). Practitioners can submit electronic signatures to suppliers as needed.
Question: Regarding oxygen patients who are not able to be seen by a physician according to the timeframe typically required by the LCD, may they continue receiving oxygen and is it appropriate for the supplier to submit a bill, since the CMS-1744-IFC (April 6, 2020) waives clinical requirements during the public health emergency?
Answer: Yes, they may continue to receive oxygen and yes, the supplier may submit a bill. Face-to-face requirements for evaluations, assessments, certifications or other implied face-to-face services as required in NCDs and LCDs do not apply during the PHE for the COVID-19 PHE. The safety of the patient needs to be considered regarding the setting for patient treatment. Accordingly, the healthcare professional will need to use their clinical judgment. We remind physicians, practitioners and suppliers that services and equipment furnished to patients must be reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act. Accordingly, the medical record should be sufficient to demonstrate that payment for the services billed is warranted (that is, the services were actually provided, were provided at the level billed, and were medically necessary)
Question: Since in-home assessments for power mobility devices require the supplier to be face-to-face with the beneficiary, can a virtual in-home assessment be performed to meet NCD/LCD coverage criteria and ensure an item is appropriate to the beneficiary’s environment?
Answer: The supplier must ensure that the item furnished is both medically necessary and able to be used in the beneficiary’s home environment. If this can be ascertained and documented via virtual means, this is acceptable.
Question: The NCD 240.2 home oxygen policy specifies certain health conditions must be met for coverage. Are these conditions for coverage being enforced during the PHE for the COVID-19 PHE?
Answer: No. As specified in the CMS-1744-IFC (April 6, 2020), clinical indications for certain respiratory policies will not be enforced during the PHE for the COVID-19 PHE, including NCD 240.2 home oxygen. At the conclusion of the PHE for the COVID-19 PHE, we will return to enforcement of these clinical indications for coverage. We remind physicians, practitioners, and suppliers that services and equipment furnished to patients must be reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act. Accordingly, the medical record should be sufficient to demonstrate that payment for the services billed is warranted (that is, the services were actually provided, were provided at the level billed, and were medically necessary).
Question: Does CMS-1744-IFC (April 6, 2020) temporarily waive restrictions around acquiring supplemental O2 and comfort medications for end of life care outside of the hospice setting, in the beneficiary’s home?
Answer: The current NCDs and LCDs that otherwise restrict coverage of home-use of oxygen to certain clinical conditions will not be enforced during the public health emergency for the COVID-19 PHE. This change is intended to allow practitioners flexibility to treat their patients with home-use of oxygen during this emergency. This enforcement discretion will apply only during the PHE for the COVID–19 pandemic. At the conclusion of the PHE for the COVID–19 pandemic, we will return to enforcement of these clinical indications for coverage. CMS-1744-IFC (April 6, 2020) does not prevent enforcement of any policies related to medications related to end of life care whether the services are furnished in a hospice setting or outside of a hospice setting.
Question: Can a telehealth service meet the face-to-face requirement for a prosthetic?
Answer: Perhaps. The regulation at 42 CFR 410.38 recognizes that the face-to-face requirements can be satisfied by using telehealth services for some prosthetic devices. Under the regulations, CMS established a master list of DMEPOS items potentially subject to face-to-face and other requirements that are items of DMEPOS that CMS has identified in accordance with sections 1834(a)(11)(B) and 1834(a)(15) of the Social Security Act. The criteria for this list are specified in 42 CFR 414.234. The Master List serves as a library of DMEPOS items from which items may be selected for inclusion on Required Face-to-Face Encounter and Written Order Prior to Delivery List and/or the Required Prior Authorization List.
Question: Can I use telehealth to satisfy the face-to-face requirement in NCDs and LCDs during the COVID-19 public health emergency (PHE)?
Answer: During the COVID-19 PHE, we will not enforce the face-to-face requirements required through NCDs, LCDs, or articles. To the extent that a provider, supplier, or physician would like to use telehealth services during this period in lieu of a face-to-face visit that would otherwise be specified in an NCD, LCD, or article, they are free to do so. For periods outside of the public health emergency, please consult existing instructions when telehealth services could be used to satisfy NCD and LCD requirements in accordance with the Agency’s current telehealth guidance. https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/index.
Note that certain items of durable medical equipment may have different requirements that are not addressed in NCDs and LCDs but are instead required by statute, regulation, or the DMEPOS Quality Standards (https://www.cms.gov/Outreach-and-Education/MedicareLearning-Network-MLN/MLNProducts/DMEPOSQuality/DMEPOSQualBooklet-905709.html). Those requirements are still enforceable during the COVID-19 PHE.