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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules state that coverage and payment for Medicare telehealth services includes consultation, office visits, 
individual psychotherapy, and pharmacologic management delivered via a telecommunications system. 
Eligible geographic areas include rural health professional shortage areas (HPSA) and counties not classified as 
a metropolitan statistical area (MSA). The originating site for telehealth services (location to which the enrollee 
presents) must be a practitioner?s office, hospital, rural health clinic (RHC), federally qualified health center 
(FQHC), skilled nursing facility or community mental health center. You can find this rule in the Medicare 
Claims Processing Manual, Chapter 12, Sections 190.1 and 190.2. 
  
The rules say that for eligible telehealth services, telecommunications systems substitute for an in-person 
encounter. Medicare enrollees are eligible for telehealth services only if they are presented from an originating 
site located in either a county outside of a Metropolitan Statistical Area (MSA) or a rural Health Professional 
Shortage Area (HPSA) located in a rural census tract. You can find this in the CMS MLN document entitled 
?Telehealth Services.? 
 
Medicare guidance says the supplier for all Durable Medical Equipment, Prosthetic, and Orthotic Supplies 
(DMEPOS) is required to keep on file a physician prescription (order). A supplier must have an order from the 
treating physician before dispensing any DMEPOS item to a beneficiary. All DMEPOS items other than those 
referenced in 42 CFR 410.38(c)(4) and 410.38(g)(2) require detailed written orders prior to billing. Detailed 
written orders may take the form of a photocopy, facsimile image, electronically maintained, or original "pen-
and-ink? document. (See chapter 3, section 3.3.2.4). The written order must be sufficiently detailed, including 
all options or additional features that will be separately billed or that will require an upgraded code. The 
description can be either a narrative description (e.g., lightweight wheelchair base) or a brand name/model 
number. All orders must clearly specify the start date of the order. A written order prior to delivery is required 
for certain DMEPOS items as specified in 42 CFR 410.38(c)(4) and 410.38(g)(2). For these items, the supplier 
must have received a written order that has been both signed and dated by the treating physician/practitioner 
before dispensing the item. If a supplier bills for an item without a written order prior to delivery, the item will 
be denied. For a covered DME item, outlined in 42 CFR 410.38(g), the contractor shall ensure that the written 
order is consistent with requirements in 42 CFR 410.38(g)(4). This order must include, the beneficiary?s name, 
the item of DME ordered, the NPI of the prescribing physician/practitioner, the signature of the prescribing 
physician/practitioner and the date of the order. If this information is not included on the written order, the 
claim will be denied. Medicare requires that the written order is completed after the face-to-face encounter. If 
the date of the written order is prior to the date of the face-to-face encounter, the contractor shall deny the 
claim.  
 
You can find this guidance in the Medicare Program Integrity Manual Chapter 5 ? Items and Services Having 
Special DME Review Considerations, 5.2.1 - Physician Orders, 5.2.3 ? Detailed Written Orders and 5.2.4 ? 
Written Orders Prior to Delivery (A and C).C11. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.