The DMEPOS Written Order
Medicare pays for durable medical equipment, prosthetics, orthotics and supplies only where a written order exists, and the rule is broader than most practices assume: it applies to every DMEPOS item, not just the expensive or unusual ones. What varies is the deadline. For most items the order has to reach the supplier before the claim is submitted. For items CMS has placed on one particular list, it has to be there before the item is delivered — and a face-to-face encounter has to have happened first. That encounter requirement is this benefit's own, set by a different regulation from the home health face-to-face encounter, with a different window and a different purpose.
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Key takeaways
- All DMEPOS items require a written order or prescription as a condition of Medicare payment, and 42 CFR 410.38(d)(1)(i) names the six elements it must contain.
- The timing depends on one thing: whether the item is on the Required Face-to-Face Encounter and Written Order Prior to Delivery List. If it is, the order must reach the supplier before delivery. If it is not, before claim submission.
- The Master List is a library, not a requirement. Being on it means an item could be selected for those conditions — only items actually selected and announced in the Federal Register carry them.
- The face-to-face encounter, where required, must have occurred within the six months preceding the date of the written order, and must be documented in the medical record with the specific findings that support the item.
- The lists are updated periodically. The set in force today took effect in April 2026; the next update takes effect on 28 October 2026, so which list an item sits on is a lookup rather than a memory.
The written order, and the six elements
A written order or prescription, in this context, is a written communication from a treating practitioner documenting the need for a beneficiary to be provided an item of DMEPOS. The regulation makes it a condition of payment for every DMEPOS item, and specifies what it has to contain.
- The beneficiary's name, or the Medicare Beneficiary Identifier.
- A general description of the item.
- The quantity to be dispensed, if applicable.
- The order date.
- The treating practitioner's name, or National Provider Identifier.
- The treating practitioner's signature.
A general description is the standard, not a code
"Treating practitioner" here has a defined meaning: a physician, or a physician assistant, nurse practitioner, or clinical nurse specialist. It is narrower than the set of people who might document a need in the chart, and the signature has to be the treating practitioner's.
The only question that changes the deadline
There are exactly two timing rules, and which one applies turns on a single fact about the item.
| The item | When the order must reach the supplier | Is a face-to-face encounter required |
|---|---|---|
| A power mobility device, or any other item on the Required Face-to-Face Encounter and Written Order Prior to Delivery List | Before delivery. | Yes — the treating practitioner must document and communicate to the supplier that an encounter occurred within the six months preceding the date of the written order. |
| Every other DMEPOS item | Before the claim is submitted. | Not by this rule. |
Both rows still require a written order. The distinction is when, not whether.
Before delivery means the order is a prerequisite, not paperwork
Three lists, and only two of them impose anything
The vocabulary here causes real confusion, because the best-known list is the one that requires nothing.
- The Master List
- The Master List of DMEPOS Items Potentially Subject to Face-to-Face Encounter and Written Orders Prior to Delivery and/or Prior Authorization Requirements. The regulation calls it a library: a pool of items from which CMS may select for the other two lists. Membership alone imposes no condition of payment. The word doing the work in its title is "potentially".
- The Required Face-to-Face Encounter and Written Order Prior to Delivery List
- Items selected from the Master List and actually made subject to the encounter and prior-to-delivery order conditions. This is the list that changes the deadline. Power mobility devices are on it by statute.
- The Required Prior Authorization List
- Items selected from the Master List and made subject to prior authorization as a condition of payment — a provisional affirmation obtained before the item is furnished and before the claim is filed.
The sentence that resolves it
How items reach the Master List is set out at 42 CFR 414.234(b)(1), and it is worth knowing the shape of it because it explains why the list moves. Items qualify by meeting a payment threshold — stated in the regulation and adjusted annually for inflation — while also having been identified as high risk in a national Office of Inspector General or Government Accountability Office report or in the Comprehensive Error Rate Testing improper payment data; or by showing aberrant billing growth against stated tests; or by requiring an encounter, a prior-to-delivery order, or prior authorization by statute. Items also come off, including after a defined period without a further adverse finding, when they stop being covered, or when the code is discontinued and cross-walked.
The lists move, and the current set has a date
Because the lists are self-updating and republished, an item's status is a fact with a date attached. Two dates matter right now.
The set in force today took effect in April 2026
The most recent update to all three lists was published in the Federal Register on 13 January 2026 and took effect on 13 April 2026. That is the version a practice is working against as this article is published.The next update takes effect on 28 October 2026
A further notice published on 30 July 2026 updates all three lists again, effective 28 October 2026. The regulation requires a notice period of no less than 60 days before such a list takes effect, which is why the announcement runs well ahead of the date.One item category phases in by state, later still
The July 2026 notice implements the prior-authorization requirement for one category of orthoses in three phases across named groups of states, beginning on 28 October 2026 and completing in April 2027. Which phase applies depends on where the beneficiary is, so this is a case to check against the notice itself rather than to generalize.Treat the list as a lookup, not as knowledge
CMS posts the current lists on its own site alongside the Federal Register notices. Because items are added and removed on a recurring cycle, an internal list of which items need a prior-to-delivery order is a maintenance obligation, and a stale copy of it is the failure mode this design produces.
What the October date does and does not change
The record behind the order
The order is the artifact the supplier needs. The record that supports it is a separate obligation, and it is where the money is usually lost.
A supplier must keep the written order and the supporting documentation the treating practitioner provided, and make both available to CMS and its agents on request. On request, the supplier must also submit additional documentation to support or substantiate the medical necessity of the item. That documentation comes from the practitioner, which is why a supplier's records request is really a request to the ordering practice.
Where a face-to-face encounter is required, the regulation is specific about what the record must show. The encounter has to be documented in the pertinent portion of the medical record — the regulation gives history, physical examination, diagnostic tests, summary of findings, progress notes and treatment plans as examples — and the supporting documentation must include subjective and objective beneficiary-specific information used for diagnosing, treating or managing the clinical condition the item is ordered for. A note recording that an encounter took place, without that content, does not meet the standard.
Recurring supplies have their own rules
CMS can suspend these requirements without rulemaking
Common questions
Do DMEPOS written order rules take effect in October 2026?
No. The written order requirement is in force now and has been since the framework took effect at the start of 2020, codified at 42 CFR 410.38. What takes effect on 28 October 2026 is a periodic update to the HCPCS codes on the Master List, the Required Face-to-Face Encounter and Written Order Prior to Delivery List, and the Required Prior Authorization List, published on 30 July 2026. The lists a practice works against today were set by a notice published on 13 January 2026 and effective 13 April 2026. The obligations do not change in October; the membership of the lists does.
Does every DMEPOS item need a written order?
Yes. 42 CFR 410.38(d)(1) states that all DMEPOS items require a written order or prescription for Medicare payment. The list machinery does not decide whether an order is needed — it decides when the order must reach the supplier, and whether a face-to-face encounter must have preceded it.
What has to be on the written order?
Six elements: the beneficiary's name or Medicare Beneficiary Identifier; a general description of the item; the quantity to be dispensed, where applicable; the order date; the treating practitioner's name or National Provider Identifier; and the treating practitioner's signature. Medicare contractors are directed to consider the totality of the medical records when reviewing for compliance with these elements, so the order is assessed alongside the chart rather than in isolation.
If an item is on the Master List, does it need a face-to-face encounter?
Not by virtue of being on the Master List. The Master List is described in the regulation as a library of items from which CMS may select for the other two lists, and CMS states in its notices that only items selected and announced through a Federal Register notice are subject to those conditions of payment. The question to answer for a specific item is whether it currently appears on the Required Face-to-Face Encounter and Written Order Prior to Delivery List or the Required Prior Authorization List.
How long before the order does the face-to-face encounter have to happen?
Where an encounter is required, the treating practitioner must document and communicate to the supplier that a face-to-face encounter with the beneficiary occurred within the six months preceding the date of the written order. The encounter must have been for the purpose of gathering subjective and objective information associated with diagnosing, treating, or managing the clinical condition the item is ordered for — and where it was conducted by telehealth, the Medicare telehealth conditions apply.
Can the order be provided after the item has been delivered?
It depends on the item. For items on the Required Face-to-Face Encounter and Written Order Prior to Delivery List, the order must be communicated to the supplier before delivery, and an order produced afterwards does not satisfy a condition framed as a sequence. For all other DMEPOS items, the order must be communicated to the supplier before the claim is submitted, so there is room between delivery and billing — but not after billing.
Terms used here
Definitions for the vocabulary this article assumes.
Continue learning
Where to go next.
Medicare billing
The cluster this sits in — how the program is structured, billed, and denied.
What makes an item durable medical equipment
The prior question: whether the item is in this benefit at all, before any order rule applies.
The prosthetic device benefit
A separate benefit with its own test, which the same physical item can fall into instead.
The home health face-to-face encounter
The other Medicare requirement built on a documented encounter — with different rules and a different window.
What is prior authorization
The condition attached to the third list, and how provisional affirmation works.
Responding to a payer records request
What to do when a supplier or contractor asks the ordering practice for the record behind the order.
Authoritative sources
- 42 CFR 410.38 — Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS): Scope and conditions (opens in a new tab)
The section carrying the requirement. Paragraph (c) defines treating practitioner, written order/prescription, face-to-face encounter, power mobility device, the Master List, and the Required Face-to-Face Encounter and Written Order Prior to Delivery List — including that the latter is published in the Federal Register, posted on the CMS website, and effective no less than 60 days after publication. Paragraph (d)(1) makes a written order a condition of payment for all DMEPOS items, names its six required elements at (d)(1)(i), and sets the two timing rules at (d)(1)(ii). Paragraph (d)(2) sets the face-to-face encounter requirement and its six-month window for items on that list; (d)(3) the documentation and record requirements; (d)(4) the refill rules for recurring items. Paragraph (e) permits CMS to suspend the encounter and prior-to-delivery requirements without rulemaking, except where inclusion was statutory.
- 42 CFR 414.234 — Prior authorization for items frequently subject to unnecessary utilization (opens in a new tab)
Defines prior authorization, provisional affirmation, the Required Prior Authorization List, and unnecessary utilization. Paragraph (b) sets the Master List inclusion criteria — a payment threshold adjusted annually for inflation combined with identification in a national OIG or GAO report or the CERT improper payment data; aberrant billing growth against stated tests; or a statutory requirement for an encounter, a prior-to-delivery order, or prior authorization — and provides that the list is self-updating at minimum annually and published in the Federal Register. It also sets the removal rules. Paragraph (c) makes prior authorization a condition of payment for selected items and permits CMS to implement it nationally or locally.
- Updates to the Master List, the Required Face-to-Face Encounter and Written Order Prior to Delivery List, and the Required Prior Authorization List (CMS-6109-N), 91 FR 47972 (opens in a new tab)
Published 30 July 2026, effective 28 October 2026 — the next periodic update to the three lists, and the source for the phased implementation of prior authorization for one category of orthoses. Its background section records that the framework comes from the November 2019 final rule (84 FR 60648) effective 1 January 2020, that the requirements were codified at 42 CFR 410.38 and the Master List machinery at 42 CFR 414.234, that the Master List was last updated by the notice published 13 January 2026 at 91 FR 1250, and — the sentence that resolves what Master List membership means — that only those items selected and announced via Federal Register notice are subject to such regulatory conditions of payment.
- CMS — DMEPOS order requirements (the Required Face-to-Face Encounter and Written Order Prior to Delivery List) (opens in a new tab)
The CMS page the July 2026 notice points to for the Required Face-to-Face Encounter and Written Order Prior to Delivery List. This is the lookup for the question that decides the deadline: whether a specific item currently sits on that list.
- CMS — Prior authorization process for certain DMEPOS items (the Master List and the Required Prior Authorization List) (opens in a new tab)
The CMS page the July 2026 notice points to for the Master List and the Required Prior Authorization List, alongside the program's operational material. Both CMS pages were resolved from the shortlinks printed in the notice itself and confirmed to load during this article's research.