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FAQs

Workers Compensation

Physicians generally can provide DME within the scope of his or her practice, provided that the physician complies with applicable State laws, including any applicable State physician self-referral prohibitions or restrictions. Some states have established fee schedules for medical equipment and medical supplies. Other states may have a limiting cost plus formula established for reimbursement. Physicians should consult with counsel regarding state licensing requirements and self referral prohibitions or restrictions.

Medicare

Physicians generally can provide certain ambulatory items only to a patient in office such as crutches, canes, walkers and folding manual wheelchairs if the arrangement meets the requirements of an applicable exception to the Stark self-referral prohibition. Providing any other items of DME is prohibited unless the physician personally provides the item to the patient, is licensed as a DMEPOS Supplier by NSC and documents personal compliance with all professional supplier and quality standards. Physicians should consult with counsel regarding state licensing requirements and self referral prohibitions or restrictions.

Other Federally Funded

Same as Medicare, however there also may be additional requirements in State Medicaid programs regarding treatment authorization, licensing or credentialing. Physicians should consult with counsel regarding state licensing requirements and self referral prohibitions or restrictions.

Group/Private

Physicians generally can provide DME within the scope of his or her practice, provided that the physician complies with applicable State laws, including any applicable physician self-referral prohibitions or restrictions. Some insurance companies may have restrictions so pre-authorization is recommended. Physicians should consult with counsel regarding state licensing requirements and self referral prohibitions or restrictions.