The new prospective payment system proposed rule from the Centers for Medicare & Medicaid Services (CMS) is clarifying that a face-to-face examination is not always needed for replacement durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) orders.
CMS also released a fact sheet on July 1, the same day as the Calendar Year 2027 Home Health Prospective Payment System Proposed Rule (CMS-1844-P) was announced.
“CMS is proposing to clarify that an additional comprehensive beneficiary ‘face-to-face’ examination to gather ‘subjective and objective information associated with diagnosing, treating or managing a clinical condition for which the DMEPOS is ordered’ is not necessary when the item being ordered and furnished is a replacement item,” the fact sheet said.
The impacted equipment would need to be “an item described by the same Healthcare Common Procedure Coding System (HCPCS) code,” the fact sheet added.
If the replacement DMEPOS item is later included in an audit, “the provider must nevertheless submit documentation from the original face-to-face encounter to demonstrate that medical necessity, billing and coverage requirements have been satisfied.”
“Accordingly, the intent of 42 C.F.R. 410.38, which requires a face-to-face encounter for certain DMEPOS items, would continue to apply when the item is initially furnished,” the fact sheet added. “However, this clarification would make clear that the face-to-face encounter would not need to be repeated solely for replacement items.”
Clinician Task Force (CTF) Executive Director Tamara Kittelson, MS, OTR/L, ATP/SMS, has acknowledged that changing to the face-to-face process could be “a timesaver,” because promptly scheduling face-to-face appointments with physicians can be difficult.
But for Complex Rehab Technology replacement, Kittelson expressed concern over potentially eliminating clinical evaluations because beneficiaries’ conditions, functional abilities and cognitive abilities are constantly changing. Those changes wouldn’t be noticed or considered if replacement DMEPOS orders are submitted without face-to-face appointments happening first.
In a Sept. 24, 2025, letter sent by CTF to CMS, the organization said, “We recognize and appreciate CMS’s efforts to reduce administrative burden and improve efficiency in provision of certain types of durable medical equipment. But we are concerned about unintended consequences when this policy shift is applied to Complex Rehabilitation Technology as well as some types of DME.”
