DMEPOS Master List.

In plain English

The DMEPOS Master List is a list Medicare keeps of durable medical equipment, prosthetics, orthotics, and supplies that it has flagged as possible weak points for fraud, unnecessary use, or improper payment. Its full name is the Master List of Items Potentially Subject to Face-to-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements, and the regulation calls it a library of items from which narrower lists are drawn. An item gets on it in one of three ways: it meets a cost test that is adjusted every year and has been flagged in a national government report for fraud, unnecessary use, or improper payments; it is a high-volume item whose payments jump abnormally from one year to the next; or a statute already requires one of the extra steps for it. CMS selects items from it for two required lists, one needing a face-to-face encounter and a written order before delivery, and one needing prior authorization as a condition of payment. The Master List updates at least once a year and is published in the Federal Register.

01Why it matters

People who find an item they need on the Master List often assume it now needs approval before it can be delivered. It does not. CMS says only those items that are selected and announced via Federal Register notice are subject to the extra conditions of payment, so the list worth checking is the required list, not the Master List.

02The math, step by step

A supplier mentions that a knee brace a family is ordering is on Medicare's Master List. On its own that says nothing about extra paperwork. What matters is whether that brace has also been selected, in a published notice, for the Required Prior Authorization List or the face-to-face list, and from what date.

Illustrative example. The amounts here are hypothetical, chosen to show how the math works, not real quoted rates or figures.

03What this is NOT

04Receipts

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