COVID-19 Update: DME MACs Publish Guidance Regarding Physician Telehealth Visits During COVID-19


AOPA staff recently participated in educational webinars presented by the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) and on DME MAC provider advisory councils during which they  confirmed that physicians, including MDs and DOs that are certifying the medical need for diabetic shoes may utilize telehealth to fulfill face-to-face encounter requirements during the COVID-19 Public Health Emergency (PHE). 

On April 6, 2020 the Centers for Medicare and Medicaid Services (CMS) released an Interim Final Rule with Comment Period (IFC) that indicated for claims with dates of service on or after March 1, 2020, policy based “requirements for face-to-face or in-person encounter for evaluations, assessments, certifications or other implied face-to-face services would not apply during the COVID-19 PHE.”

Additional guidance was provided on the IFC by the DME MACs on May 7, 2020 in a joint educational article.  The DME MAC article indicated that while the IFC provided significant relief from policy-based face-to-face visit requirements, a subsequent CMS IFC that was issued on May 8, 2020 reiterated the statutory requirement to establish and document the medical necessity for Medicare covered services.  The DME MAC article indicated that Medicare approved, physician-based telehealth visits, including those that meet the relaxed telehealth rules in effect during the COVID-19 PHE, will be considered compliant for purposes of establishing and documenting the medical necessity of Medicare covered services.  Telehealth based physician encounters will also meet any face-to-face visit requirements that are incorporated into existing Medicare policies. 

The DME MAC joint article indicated that the IFC based waiver of face-to-face encounter requirements only applies to policy-based requirements and therefore does not apply to face-to-face encounter requirements that are memorialized elsewhere, specifically those that are part of the DMEPOS Quality Standards or Social Security Act.  This led to significant questions, especially related to Medicare coverage of therapeutic shoes which require in-person visits with the certifying physician and the supplier of the shoes.  While the IFC allows certifying physicians to use telehealth encounters to certify the medical necessity of diabetic shoes, suppliers of diabetic shoes, including orthotists, prosthetists, and pedorthists will still be required to perform an in-person evaluation at the time of shoe selection and an in-person fitting of the shoes at delivery as these are addressed in Appendix C of the DMEPOS Quality Standards.

Access the DME MAC guidance article on the CMS IFC.

Questions regarding this issue may be directed to Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org.

For more on telehealth join AOPA next Tuesday, May 19 from 3:30 to 4:45pm ET as we will hold our second Townhall, Operating During the Pandemic: Telehealth and Continuum of Care.