Medicare Delays Face-to-Face Encounter Requirement for Certain Durable Medical Equipment


On September 9, 2013, CMS announced that it would delay a requirement that medical providers have a face-to-face encounter with a Medicare beneficiary within six months of prescribing certain durable medical equipment (DME).  As stated in CMS’s notice, which it posted on its website, the delay is a result of CMS’s “continued concerns that some providers and suppliers may need additional time to establish operational protocols . . . .”  According to the notice, the date for enforcement of the requirement will be announced in 2014. 

Section 6407 of the Affordable Care Act (ACA) established a face-to-face encounter requirement for certain DME items.  The law requires a physician to document that a physician, nurse practitioner, physician assistant, or clinical nurse specialist has had a face-to-face encounter with the patient. The 2013 Medicare physician fee schedule, published in November 2012, required a face-to-face encounter as a condition of Medicare reimbursement for orders written for certain DME on or after July 1, 2013.  In June 2013, however, CMS pushed the compliance date forward to October 1, 2013.  Despite the second enforcement delay to 2014, CMS stated in its notice that “[t]hose suppliers and physicians who are currently implementing the face-to-face requirements should continue to do so.” 

To view CMS’s announcement, click here

Reporter, Lora L. Greene, New York, +1 212 556 2174,

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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