What six elements must a Standard Written Order contain?

Patient name or MBI, order date, general description of the item (plain description, HCPCS code/narrative, or brand/model), quantity where applicable, treating practitioner name or NPI, and the treating practitioner's signature — handwritten or electronic, no signature or date stamps. Separately billed options, accessories and supplies must be listed separately. The order must be completed within 6 months after a required face-to-face encounter.

Which orders must be signed before delivery?

Items on CMS's Required List — always power mobility devices plus additional items CMS selects via Federal Register — require both the face-to-face encounter and a completed signed SWO before delivery. The order date must be on or before the delivery date. If not, the claim is denied with EY and the penalty follows timing, not paperwork.

What must the chart show besides the order?

The contemporaneous medical record must substantiate type, quantity and frequency — diagnosis, duration, clinical course, prognosis, functional limitations, other treatments tried and past equipment experience. Supplier-prepared statements, physician attestations and checkbox templates alone do not carry a claim; they must be corroborated by your note.

Clinicians → Coverage & Documentation · Last reviewed August 17, 2026

How to Write an Order Medicare Will Pay

SWO/DWO — the 6 elements, SWO prior to delivery, and the face-to-face encounter

The floor underneath every piece of equipment we deliver — oxygen, beds, wheelchairs, walkers, nebulizers, PAP, commodes, lifts, surfaces. Each category adds its own clinical criteria on top; this page is the floor. Based on Standard Documentation Requirements A55426 (applies to every DMEPOS claim). Where A55426 and an LCD/Policy Article disagree, the LCD/Policy Article wins.

Fax: (800) 438-2048 · Phone: (800) 977-3002 — we confirm receipt and next steps by phoneDownload cover sheet ↓

If you only read one section, read this one.

Three things have to exist before we can bill Medicare for anything:

Standard Written Order — 6 elements, signed by the treating practitioner. See the 6 →
Documentation in your medical record that supports the equipment. Not our form. Your note. What it must show →
Proof of delivery — which we handle. What counts →

We will draft the order for you — send the note and we fax back an SWO ready for signature. Fax (800) 438-2048.

Where this bites: the order that arrived after the truck.
For Required List items the signed order must reach us before the equipment does. If it does not, the claim is denied — and getting it signed afterward does not fix it. If a later unrelated supplier with the order gets paid, the penalty follows timing, not paperwork. Call (800) 977-3002 with the item and we will tell you exactly what must be signed before delivery.

The Standard Written Order — 6 elements

DWO is the old name — SWO is the current term. Same six elements. Every claim requires a written order from the treating practitioner containing all six:

Details for face to face swo
#	Element	What satisfies it
1	Patient's name or Medicare Beneficiary Identifier	Either one
2	Order date	Date it was written
3	General description of the item	Plain description ("wheelchair," "hospital bed"), HCPCS code, HCPCS narrative, or brand + model
4	Quantity to be dispensed	Where it applies
5	Treating practitioner's name or NPI	Either one
6	Treating practitioner's signature	See signature rules below — stamps not allowed

For equipment: list every concurrently ordered option/accessory/added feature that is separately billed or requires an upgraded code — each one listed separately. For supplies: each separately billed supply on its own line.

Signature rules

Must comply with CMS signature requirements — MPIM Ch. 3, §3.3.2.4
Signature stamps and date stamps are not allowed — the single most common reason a perfect order comes back
For items other than power mobility, someone else in your office may fill in certain elements — but the treating practitioner must sign it
Power mobility: the practitioner who did the face-to-face must be the one who writes the order

Who counts as a "treating practitioner"

Physician, physician assistant, nurse practitioner, or clinical nurse specialist — within state scope of practice
Chiropractors are not permitted to prescribe DMEPOS
If we bill without a completed order, we must add the EY modifier — which is a denial. That is why we hold delivery rather than accept a verbal.

When you need to write a new order

Details for face to face swo
Trigger	New order?
Any purchase or initial rental	Yes
Change in order — different item, different quantity	Yes
Item is replaced	Yes
Patient changes suppliers and new supplier cannot get the valid order from the old one	Yes
On a regular basis, nothing changed	Only when a specific equipment policy says so

Orders that must be signed before delivery

A written order prior to delivery (WOPD) is just a completed SWO that reaches us before the equipment does. CMS maintains a Required List of items subject to both face-to-face and WOPD — statute requires it for power mobility devices always, plus additional items CMS selects and publishes via the Federal Register. That list is maintained separately from the equipment LCDs and updated periodically — we track it.

Two timing rules that do not bend:

The order date must be on or before the delivery date
The order must be completed within 6 months after the required face-to-face encounter

Rather than guess from a page, call (800) 977-3002 with the item and we will tell you exactly what must be signed before the truck rolls.

The face-to-face encounter

For Required List items, the treating practitioner must have a face-to-face encounter with the patient within the 6 months before prescribing. CMS-approved telehealth encounters count when they meet telehealth requirements.

What the encounter documentation has to do

Support payment for the specific items ordered
Live in the pertinent part of the medical record — history, physical, diagnostic tests, findings, progress notes, treatment plans
Include subjective and objective patient-specific information used to diagnose, treat, or manage the condition the equipment is for

Two practical points:
For items other than power mobility, the prescriber does not have to be the person who did the encounter — but the prescriber must verify a qualifying encounter happened within the prior 6 months and have documentation of it.
A new qualifying encounter is required each time a new order is written for a Required List item — the one exception is replacing an identical item (same HCPCS) after its useful lifetime has expired. The 6-month rule does not replace the equipment's own clinical coverage criteria.

What your medical record has to show

This is where most denials happen, and it has nothing to do with the order form. In a claim review, the contemporaneous medical record is the source that justifies payment.

Your office notes, hospital, nursing facility, home health, other clinicians, test reports — must contain enough about the condition to substantiate the type, quantity, and frequency of use or replacement:

Diagnosis, duration of the condition, clinical course (worsening/improving), prognosis
Nature and extent of functional limitations
Other treatments tried and how they worked, and past experience with related equipment

The four things that will not carry a claim by themselves

Details for face to face swo
What people send	Why it fails
Supplier-prepared statement	Records from anyone with a financial interest in the claim are not sufficient alone — including ours
Physician attestation	Not sufficient by itself, even signed by the ordering physician
Completed template or checkbox form	Subject to corroboration against the actual medical record
Clinical detail on the prescription	May be included, but must be corroborated by the medical record

A form can restate what the chart says, but it cannot replace it. When we ask for "the whole note" instead of accepting our own form back, this is why. Reimbursement is based on utilization that contemporaneous records support — not what was ordered.

Keeping it covered — continued need and continued use

For purchased items and the first months of a rental, justification comes from records created before or at the initial order. Entries must predate or coincide with the first date of service. For rented equipment and ongoing supplies, the record must keep supporting the item over time.

Continued medical need — any one serves:

Recent order for refills of supplies
Recent order for repairs
Recent change in the order
Timely documentation showing the patient is using the item

"Timely" = within the preceding 12 months unless a specific policy says otherwise. For some items, initial justification that the condition is permanent establishes the benefit category and ongoing documentation is not required — the Policy Article says when.

Continued use — we must monitor

We are required to monitor whether rented equipment and ongoing supplies are actually being used, and to stop billing when they are not. No monitoring required for purchased or capped-rental-converted items.

Confirms continued use: timely chart documentation showing usage; our records of a compliant refill request; or our record of the patient confirming continued use of a rental item. If the patient stops, tell us — that call stops a bill nobody wants to argue about.

Refills

You do not need to write a prescription for a routine refill. What is required is a documented request from the patient, every time.

Details for face to face swo
Rule	Detail
Picked up in person at retail	Signed delivery slip or itemized sales receipt is enough
Delivered to patient	Request must be individualized — patient/caregiver affirms need — and documented before shipment
Method of contact	Medicare does not prescribe it — phone, text, email all work if every required element is captured
After the fact	A retrospective attestation is not sufficient. Request must precede shipment.

Every refill record must include: patient's name (or authorized representative if different), description of each item requested, documentation of an affirmative response, and the date of request. That is why the patient gets a call before every shipment — a condition of payment, not a sales call.

Proof of delivery

We maintain this and it must be produced on request. Services without appropriate proof of delivery are denied and overpayments are recovered. The date of service is generally the date of delivery.

Details for face to face swo
Method	Record must contain
Direct delivery by us	Patient name, delivery address, description, quantity, date delivered, and signature of patient or designee
Shipping / delivery service	All of the above + tracking/invoice number linking our shipping docs to carrier records + evidence of delivery
Delivery to a nursing facility	Documentation we delivered to facility and documentation from facility showing patient received and used the items

We may not sign for the patient — nobody with a financial interest in delivery (us, employees, anyone) may act as designee. A neighbor/family member may, with relationship noted. When both supplier and patient dates appear, the patient's date is the date of service. No billing before discharge — we may deliver equipment (not supplies) to an inpatient facility up to 2 days before anticipated discharge for fitting/training; claim is dated discharge date and item must go home with patient.

Repairs and replacement

Two different things — Medicare treats them differently:

Repair — fixes or mends

Fixes damage/wear to put back in good condition. Replacing a part/component of the base item is a repair.

No new practitioner order needed for a repair
If Medicare paid for the base item, medical necessity for the base is already established
Document: item still reasonable & necessary and repair itself is reasonable & necessary
Routine periodic maintenance (testing, cleaning, regulating, checking) is not covered

Medicare does not separately reimburse repairs for: frequent/substantial servicing category, oxygen equipment, capped rental during capped rental period, items under warranty, or previously denied items.

Replacement — provides an identical/nearly identical item

When original is lost, stolen, or irreparably damaged — specific accident or natural disaster (fire/flood).

Expect to provide police report / insurance claim
Irreparable wear waits out the reasonable useful lifetime — never less than 5 years of continuous use (rental or purchase). After that, patient may elect replacement.
Not covered at all for frequent/substantial servicing or inexpensive/routinely purchased rental items
Practitioner's order, where required, is needed to reaffirm medical necessity

Artificial limbs/eyes: replacement without regard to RUL when practitioner determines necessary; major components: physiological change, irreparable change, or repairs >60% of replacement cost.

Patients arriving with equipment from another plan

When a patient moves onto Medicare fee-for-service with equipment obtained elsewhere — including Medicare Advantage — the first Medicare claim is a new initial claim. Coverage does not carry over.

Details for face to face swo
What is required	Detail
All coverage, coding, documentation requirements	Must be met as of the date of that first claim
Original documentation	Records before transition may be used for order, WOPD, and face-to-face — unless a policy says otherwise
Face-to-face timing	For Required List items, encounter must have occurred within 6 months before the written order date
Proof of delivery	Required even for equipment already in the patient's possession

For equipment already in the home, our record must show a statement signed/dated by the patient confirming we examined the item, plus our attestation it meets Medicare requirements. Reasonable useful lifetime and period of continuous use start over at the first rental month Medicare pays — 4 years owned → fresh 5-year clock.

Coding, and the paperwork we own

Only CMS and the DME MACs may set HCPCS Level II coding guidelines — we are responsible for the code we bill
PDAC contractor publishes product classification lists — for some codes only products with written coding verification review may be billed at all (why we sometimes need to select the specific model)
We must keep info detailed enough to unambiguously identify the exact product delivered and code used
Not-otherwise-classified codes (miscellaneous, NOC, unlisted, non-specified) require description, manufacturer, product name/number, our price list amount, and related HCPCS on the claim — without those, rejected
Billing more than one month of a recurring supply requires narrative — "90-day supply"; certain items require date spans (diabetic testing supplies, CPM devices, parenteral/enteral nutrition, etc.)
We keep all of it for 7 years from date of service. If original qualifying documentation is older than 7 years, proof of continued medical necessity / repair necessity can serve in its place.

Referral checklist

Fax to (800) 438-2048 or call (800) 977-3002

Order has all six elements: name/MBI, date, item description, quantity, practitioner name/NPI, signature
Handwritten or electronic signature — no stamp, no date stamp
Separately billed options/accessories/supplies listed individually
Prescriber is physician, PA, NP, or CNS within state scope (not chiropractor)
Called us to confirm whether signed order must be before delivery
For Required List items: face-to-face within prior 6 months, documented in chart
Chart supports type, quantity, frequency — duration, clinical course, prognosis, functional limitations, other treatments, past equipment experience
Nothing depends on a supplier form/attestation to carry medical necessity
Office documents continued use/need at least once every 12 months; refill requests individualized and before shipment

Download cover sheet ↓Call (800) 977-3002

This guide is a plain-language summary of Standard Documentation Requirements article A55426, which applies to all DMEPOS claims submitted to the DME MACs. It is not the article itself; where this page and the governing documents differ, the governing documents control — and where A55426 and a specific LCD/Policy Article differ, the LCD/Policy Article takes precedence. Policy-specific documentation requirements live in each item's LCD-related Policy Article. Call us and we will verify before delivery — (800) 977-3002.

Source: Standard Documentation Requirements A55426. Last reviewed August 17, 2026.

Diamond Respiratory Care · 1403 Palmyrita Ave, Riverside, CA 92507
Phone (800) 977-3002 · Fax (800) 438-2048 · Hours Mon–Thu 8:00–5:00, Fri 7:00–4:00 Pacific · 24/7 oxygen supportCall us