Rule 5160-10-21 | DMEPOS: incontinence garments and related supplies.
(A) Coverage.
(1) The default certificate of medical necessity (CMN) is the ODM 02912, "Certificate of Medical Necessity: Incontinence Items" (rev. 7/2018). The CMN must include the following elements:
(a) An indication that the individual is at least thirty-six months of age;
(b) The applicable diagnosis of the specific disease, injury, developmental delay, or developmental disability causing the incontinence;
(c) The type of incontinence; and
(d) The type and quantity of incontinence garments or incontinence supplies being prescribed.
(2) Payment cannot be made for items related to stress incontinence to which no specific physiological, psychological, or physiopsychological cause can be attributed.
(3) A certification period cannot exceed twelve months.
(4) A new certification is required for an increase in the quantity of an incontinence item already prescribed or for a change in the type of incontinence item. (No new certification is needed for a decrease in quantity.)
(B) Requirements, constraints, and limitations.
(1) Incontinence items are dispensed in quantities representing one month's supply. A provider must not dispense additional incontinence items to an individual who already has at least a month's supply on hand. Before dispensing additional items, therefore, providers must make contact, either orally or in writing, with each individual (or the individual's authorized representative) to verify the current need. Providers must keep on file a summary of this contact, including in particular the following information:
(a) The quantity of items requested;
(b) The quantity of items currently on hand;
(c) The verification date, which must not be more than fourteen days before the dispensing date;
(d) The full name of the provider's representative who recorded the quantities reported; and
(e) The full name of the person (the individual or the individual's authorized representative) who reported the quantities.
(2) Payment will not be made for an incontinence item in excess of the quantity prescribed.
Last updated January 30, 2024 at 10:46 AM
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