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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. 
 
Orthopedic shoes and other supportive devices for the feet generally are not covered. However, this exclusion 
does not apply to such a shoe if it is an integral part of a leg brace, and its expense is included as part of the 
cost of the brace. Also, this exclusion does not apply to therapeutic shoes furnished to diabetics. You can find 
this rule in the Centers for Medicare and Medicaid Services, Internet Only Manual, Publication 100-02, 
Medicare Benefit Policy Manual, Chapter 15, Section 290(3). 
 
The rules say that STANDARD WRITTEN ORDER (SWO) 
 
A SWO must be communicated to the supplier prior to claim submission. For certain items of DMEPOS, a 
written order is required prior to delivery (WOPD) of the item(s) to the beneficiary (see below). 
 
A SWO must contain all of the following elements: 
 
Beneficiary's name or Medicare Beneficiary Identifier (MBI) 
Order Date 
General description of the item 
The description can be either a general description (e.g., wheelchair or hospital bed), a HCPCS code, a HCPCS 
code narrative, or a brand name/model number 
For equipment - In addition to the description of the base item, the SWO may include all concurrently ordered 
options, accessories or additional features that are separately billed or require an upgraded code (List each 
separately). 
For supplies  In addition to the description of the base item, the DMEPOS order/prescription may include all 
concurrently ordered supplies that are separately billed (List each separately) 
Quantity to be dispensed, if applicable 
Treating Practitioner Name or NPI 
Treating practitioner's signature 
 
Signatures must comply with the CMS signature requirements outlined in the Medicare Program Integrity 
Manual (CMS Pub.100-08), Chapter 3, Section 3.3.2.4. Signature and date stamps are not allowed. 
 
Upon request by a contractor, DMEPOS suppliers must provide documentation of the completed SWO. 
 In those limited instances in which the treating practitioner is also the supplier and is permitted to furnish 
specific items of DMEPOS and fulfill the role of the supplier in accordance with any applicable laws and 
policies, a SWO is not required. However, the medical record must still contain all of the required SWO 
elements. 
 
WRITTEN ORDERS PRIOR TO DELIVERY (WOPD) 
 
A WOPD is a completed SWO that is communicated to the DMEPOS supplier before delivery of the item(s). 
 
Pursuant to Final Rule 1713 (84 Fed. Reg Vol 217), CMS may select DMEPOS items appearing on the Master 
List of DMEPOS Items potentially subject to a Face-to-Face Encounter and WOPD requirement and include 
them on a Required List. 
 
The Required List will be comprised of: 
 
Statutorily required DMEPOS items such as Power Mobility Devices (PMDs); and 
Additional DMEPOS items selected by CMS appearing on the Required List. 
Items appearing on the Required List are subject to the face-to-face encounter and WOPD requirements. 
 
You can find this information in Medicare's Local Coverage Article Standard Documentation Requirements for 
All Claims Submitted to DME MACs 
(A55426). 
 
Medicare guidance says to receive payment for covered Medicare items or services from either Medicare (in 
the case of an assigned claim) or a Medicare beneficiary (in the case of an unassigned claim), a provider or 
supplier must be enrolled in the Medicare program. You can find this guidance in Medicare Code of Federal 
Regulations 42 CFR Section 424.505. You can find this document on the Centers for Medicare & Medicaid 
Services' website, www.cms.gov. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.