What Medicare actually requires, per equipment category — the same requirement set AffirmDME's compliance engine enforces, written for humans, with the LCD and CFR citations attached.
Each list mirrors the checks AffirmDME's rules engine runs for that category.
All DME The documentation Medicare requires for every DME claim — Standard Written Order elements, face-to-face rules, and medical necessity, with CFR citations.
E0601 What Medicare requires for CPAP (E0601) claims — sleep study with AHI/RDI, face-to-face timing, SWO elements — per LCD L33718, with citations.
E1390 What Medicare requires for home oxygen (E1390) — qualifying blood gas values, chronic stable state, test recency — per LCD L33797, with citations.
E0470 What Medicare requires for respiratory assist devices (E0470 BiPAP) — the four qualifying disorder pathways, testing, and documentation — per LCD L33800.
E0260 What Medicare requires for semi-electric hospital beds (E0260) — positioning need, SWO elements, face-to-face rules — per LCD L33820, with citations.
E1161 Medicare mobility device requirements — in-home mobility limitation, face-to-face exam within 6 months, specialty evaluation — per LCD L33788/L33789 and 42 CFR 410.38, with citations.
L1833 What Medicare requires for prefabricated knee orthoses L1833 and L1832 — injury/surgery or objective instability, joint laxity exam, ambulatory status — per LCD L33318, with citations. L1833 requires prior authorization from Oct 28, 2026.
L0456 What Medicare requires for thoracic-lumbar-sacral orthoses L0456, L0457 and L0486 — qualifying indication, fitting or fabrication documentation, SWO and face-to-face — per LCD L33790. Prior authorization required from Oct 28, 2026.
E0194 What Medicare requires for a Group 3 air-fluidized bed (E0194) — stage 3/4 ulcer, failed conservative treatment on a Group 2 surface, practitioner assessment within a month, monthly recertification — per LCD L33692. Prior authorization from Oct 28, 2026.
K0005 What Medicare requires for an ultralightweight manual wheelchair (K0005) — mobility criteria A–E, full-time use or individualized fitting, LCMP specialty evaluation, ATP involvement — per LCD L33788. Prior authorization from Oct 28, 2026.
L3761 What Medicare requires for off-the-shelf elbow (L3761) and wrist-hand (L3916) orthoses — there is no LCD, so the Standard Documentation Requirements govern. Prior authorization phases in by state from Oct 28, 2026; nationwide Apr 26, 2027.
E0747 What Medicare requires for electrical bone growth stimulators — nonunion with two radiograph sets 90+ days apart (E0747), failed or multilevel spinal fusion (E0748) — per LCD L33796. Not on the Required PA List; on the probationary PA list for new suppliers from Oct 15, 2026.
Orders, encounters, reviews, decisions, and deadlines — the mechanics around the packet.
ADR What a DME Additional Documentation Request (ADR) is, the response deadline, what reviewers expect in the packet, and the mistakes that turn ADRs into denials.
PA List What it means when a HCPCS code is on CMS's Required Prior Authorization List for DMEPOS: the 82 codes, the October 28, 2026 additions, phased rollouts, decision timeframes, and how the list changes.
PPA CMS's Probationary Prior Authorization process: newly enrolled DMEPOS suppliers and suppliers with a change of ownership must obtain prior authorization on 40 orthotic and osteogenesis-stimulator codes for one year, starting October 15, 2026.
PA exemption How the CMS-1828-F prior authorization exemption works for DMEPOS suppliers — the 90% threshold, the June-to-May cycle, notification and opt-out, and the 10-claim post-payment sample that decides renewal.
DME MACs The four DME MAC jurisdictions, which states Noridian and CGS cover, why the beneficiary's permanent address decides routing, and where each MAC's prior authorization portal and contacts live.
SWO The six elements every Medicare DMEPOS Standard Written Order must contain under 42 CFR 410.38(d), when the order must be in the supplier's hands, and what replaced the detailed written order and CMN/DIF forms.
F2F The 42 CFR 410.38(d)(2) face-to-face rule for DMEPOS — the six-month window, which practitioners qualify, telehealth, what the note must document, and how the Master List decides which items it applies to.
Review types How Medicare's four DME review types differ — prior authorization, Additional Documentation Requests, prepayment and post-payment review, and Targeted Probe and Educate — who starts each, when it happens, the deadlines, and what is at stake.
Non-affirmation What to do when a DMEPOS prior authorization comes back non-affirmed — reading the decision letter, unlimited resubmissions and their timeframes, the UTN, expedited review, and the ABN and secondary-payer options if you deliver anyway.
POD Medicare proof of delivery rules for DMEPOS — the three delivery methods, what each POD record must contain, date-of-service rules for shipped items and pre-discharge delivery, the seven-year retention rule, and why POD failures become denials.
PA request What a Medicare DMEPOS prior authorization request must include, how to submit it to Noridian or CGS by portal, esMD, fax, or mail, the organization tips the MACs publish, decision timeframes, and how the UTN goes on the claim.
Also: the glossary for the vocabulary, and free tools — a Required PA List lookup and a denial cost calculator.
CMS adds codes, the DME MACs revise LCDs, cycle deadlines arrive. We send a short note the week it happens, with what to do about it. No drip campaign. Unsubscribe in one click.