In the November 2012 Federal Register, the Centers for Medicare & Medicaid Services (CMS) finalized a new requirement for a face-to-face encounter prior to ordering of certain durable medical equipment (DME) including CPAP.  The effective date for this new requirement is July 1, 2013. 

Summary of Rule Requirements:
The rule specifies that the face-to-face encounter must occur within 6 months prior to the written order for new DME.  The face-to-face encounter may be performed by a physician, PA, NP or CNS.   However, if the encounter is performed by a non-physician practitioner, a physician must sign or cosign the portion of the patient’s medical record in which the encounter was documented, confirming that the encounter occurred.  A new code, G0454, will be implemented on July 1 to compensate the physician who documents encounters provided by a PA, NP or CNS.  

Additional Information:
For more information on this new requirement, review the Medicare Learning Network Article.  Further details will be included in the next edition of the Weekly Update.