Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 427.000 - Oxygen And Respiratory Therapy Equipment
Section 427.408 - Prescription Requirements

Universal Citation: 130 MA Code of Regs 130.427

Current through Register 1531, September 27, 2024

(A) The purchase or rental of any equipment or services described in 130 CMR 427.000 is reimbursable only after the provider has obtained a written prescription signed by a licensed physician or independent nurse practitioner. The prescription must be dated within 90 days of the initial date of service and include the following information:

(1) the recipient's name, address, and recipient identification number (RID);

(2) the oxygen and respiratory equipment requested;

(3) the diagnosis associated with the prescribed therapy;

(4) specific therapeutic objectives;

(5) for oxygen therapy equipment, the liter flow and hours per day;

(6) for respiratory therapy equipment, the frequency of use per day;

(7) the estimated length of time that the equipment will be used by the recipient;

(8) the prescriber's address and telephone number; and

(9) the date the prescription was signed by the prescriber.

(B) The Division shall accept a prescription in the following forms:

(1) on a sheet from the prescriber's desk pad;

(2) on the prescriber's letterhead stationery; or

(3) on a Certificate of Medical Necessity from the Durable Medical Equipment Regional Carrier (DMERC) for the federal Health Care Financing Administration's Region A. If this certificate is used, it must be completed in accordance with the instructions established by the Region A DMERC and satisfy all requirements in 130 CMR 427.000.

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