Guides / F2F
F2F Face-to-face encounter — items on CMS's Required Face-to-Face Encounter and WOPD ListMedicare DME face-to-face encounter requirements
Citations verified against the CMS Medicare Coverage Database · Reviewed September 2026
For items on CMS's Required Face-to-Face Encounter and Written Order Prior to Delivery List, 42 CFR 410.38(d)(2) requires the treating practitioner to have examined the beneficiary in a face-to-face encounter within the six months before the order was written, and to have documented that the visit was about the condition the item treats. The list currently includes all power mobility devices plus items CMS has added since 2022, including certain orthoses, support surfaces, and oxygen codes.
This guide explains the timing window, who may perform the encounter, how telehealth fits, what the note has to contain, and how CMS selects items for the list from its Master List.
The requirements, with citations
The elements below are drawn from the cited CMS and DME MAC sources, not from AffirmDME's rules engine.
Encounter within the six months preceding the order date
The treating practitioner must document a face-to-face encounter with the beneficiary within the six months before the date of the written order. This replaced the older 45-day window for power mobility devices when the 2020 rule took effect; the encounter can be older than the delivery date, but not older than six months before the order.
42 CFR 410.38(d)(2)Performed by a physician, PA, NP, or CNS
The regulation defines the treating practitioner as a physician, physician assistant, nurse practitioner, or clinical nurse specialist. Any of them may conduct the encounter and write the order; for power mobility devices the practitioner who conducted the encounter must be the one who completes the order.
42 CFR 410.38(a); Noridian SWO FAQTelehealth counts when Medicare's telehealth conditions are met
410.38(d)(2) allows a telehealth encounter if the requirements of 42 CFR 410.78 and 414.65 — Medicare's telehealth service and payment rules — are satisfied. A video visit that would not be payable as a Medicare telehealth service does not qualify as the face-to-face encounter.
42 CFR 410.38(d)(2); CMS DMEPOS Order RequirementsThe note must evaluate the beneficiary for the item's condition
The encounter has to be used for gathering subjective and objective, beneficiary-specific information for diagnosing, treating, or managing the clinical condition for which the item is ordered. A visit note that mentions the diagnosis but never assesses the patient's need for the equipment does not meet the standard.
42 CFR 410.38(d)(2); CMS DMEPOS Order RequirementsOrder in the supplier's hands before delivery
For listed items the written order must be communicated to the supplier before delivery, and the DME MACs describe the order as needing to be completed within six months after the encounter. The encounter, the order, and the delivery therefore happen in that sequence, with the encounter-to-order gap capped at six months.
42 CFR 410.38(d); Noridian PMD prior authorization pageHow items get on the list: the Master List
The Master List is a library of DMEPOS items CMS has flagged as vulnerable to unnecessary utilization, using criteria in 42 CFR 414.234 — fee-schedule cost thresholds adjusted annually, plus identification in OIG or GAO reports or CERT improper-payment data. CMS selects items from it for the face-to-face list and the Required Prior Authorization List, publishes the selections in the Federal Register, and makes them effective no less than 60 days after publication.
42 CFR 410.38(c); 42 CFR 414.234What usually sinks these claims
- The encounter is well documented but took place more than six months before the order date
- The note records the diagnosis and a medication refill but never evaluates the patient for the equipment
- For a power mobility device, the practitioner who signed the order is not the one who performed the encounter
- A telehealth visit is used as the encounter without meeting Medicare's telehealth conditions
- The item was delivered before the signed order reached the supplier
Catch the six-month miss before the MAC does
AffirmDME reads the encounter date and the order date out of the uploaded documents and shows the timing check on the readiness checklist, with the citation, so the gap is visible before you submit rather than in a non-affirmation letter.
Try it in the sandboxFAQ
Does every DME item need a face-to-face encounter?
The 410.38 six-month rule applies to items on CMS's Required Face-to-Face Encounter and Written Order Prior to Delivery List. Other items have no regulatory face-to-face condition, but their LCDs still require a medical record that establishes medical necessity, which in practice means a documented practitioner evaluation.
Can a physician assistant or nurse practitioner perform the encounter?
Yes. The regulation's definition of treating practitioner includes physician assistants, nurse practitioners, and clinical nurse specialists alongside physicians, and any of them may write the order.
Does a telehealth visit qualify?
It can, provided the visit meets the requirements of 42 CFR 410.78 and 414.65, Medicare's telehealth rules. The safest check is whether the practitioner could bill the visit to Medicare as a telehealth service.
How does AffirmDME check the six-month window?
AffirmDME's document extraction reads the encounter date from the chart note and the order date from the SWO, and the per-item readiness checklist flags an encounter outside the window with a citation to the rule, before the request is submitted.
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This guide summarizes Medicare requirements as implemented in AffirmDME's compliance engine, with citations to the governing sources. It is not legal or billing advice; LCDs and CMS policy change — always confirm against the current policy text linked above.
More guides
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- Medicare DME Documentation Requirements: the checklist every claim needs
- Medicare CPAP Documentation Requirements (E0601)
- Medicare Home Oxygen Documentation Requirements (E1390)
- Medicare BiPAP / RAD Documentation Requirements (E0470)
- Medicare Hospital Bed Documentation Requirements (E0260)
- Medicare Wheelchair & Power Mobility Prior Authorization (E1161)
- Medicare Knee Orthosis Documentation Requirements (L1833, L1832)
- Medicare TLSO Documentation Requirements (L0456, L0457, L0486)
- Medicare Air-Fluidized Bed Documentation Requirements (E0194)
- Medicare Ultralightweight Manual Wheelchair Requirements (K0005)
- Medicare Upper Limb Orthosis Requirements (L3761, L3916)
- Medicare Osteogenesis Stimulator Documentation Requirements (E0747, E0748)
- The Medicare DMEPOS Required Prior Authorization List, explained (2026)
- Probationary Prior Authorization for newly enrolled DMEPOS suppliers (Oct 15, 2026)
- The DMEPOS prior authorization exemption: how it works and how to keep it
- Which DME MAC handles your claim: Jurisdictions A, B, C, and D
- Standard Written Order (SWO) requirements for Medicare DME
- Prior authorization vs ADR vs prepayment review vs TPE: what each means for a DME claim
- After a non-affirmed prior authorization: resubmit, deliver with an ABN, or wait
- Medicare DME proof of delivery requirements
- Preparing and submitting a DMEPOS prior authorization request
Unfamiliar term? The glossary defines ADR, SWO, UTN, PTAN and the rest; the PA List lookup checks any HCPCS code.