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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 say that PCD coded as E0675 is used in the treatment of peripheral arterial disease. A PCD coded as 
E0675 to treat PAD is not eligible for reimbursement. There is insufficient evidence to demonstrate that 
reimbursement is justified. Claims for E0675 will be denied as not reasonable and necessary. A PCD coded as 
E0675 is used only for peripheral artery disease. Other PCD codes are not used for this condition. You can find 
this information in Medicare's Local Coverage Determination (LCD): Pneumatic Compression Devices 
(L33829). 
 
The rules say that the face-to-face encounter must support payment for the item(s) ordered/prescribed, and be 
documented in the pertinent portion of the medical record (for example, history, physical examination, 
diagnostic tests, summary of findings, progress notes, treatment plans or other sources of information that may 
be appropriate). The supporting documentation must include subjective and objective beneficiary specific 
information used for diagnosing, treating, or managing a clinical condition for which the DMEPOS is ordered.  
 
PROOF OF DELIVERY (POD) 
 
42 CFR 424.57(c)(12) requires suppliers to maintain POD documentation in their files. 
 
POD documentation, as well as claims documentation, must be maintained in the suppliers files for 7 years 
(starting from the DOS). 
 
No billing may be made for any DMEPOS to the DME MAC prior to the date of discharge from an inpatient 
facility. A supplier may deliver a DME, prosthetics, or orthotics item (but not supplies) to a beneficiary in an 
inpatient facility that does not qualify as the beneficiarys home, for the purpose of fitting or training the 
beneficiary in the proper use of the item. This delivery may be done up to two (2) days prior to the 
beneficiarys anticipated discharge to their home. The supplier must bill the date of service on the claim as the 
date of discharge and the supplier must ensure that the beneficiary takes the item home, or the supplier picks up 
the item at the facility and delivers it to the beneficiarys home on the date of discharge. Any attempt by the supplier and/or facility to substitute an item that is payable to the supplier for an item that, under statute, should 
be provided by the facility, may be considered fraudulent. 
 
Suppliers, their employees, or anyone else having a financial interest in the delivery of the item(s) are 
prohibited from signing and accepting an item on behalf of a beneficiary (i.e., acting as a designee on behalf of 
the beneficiary). The relationship of the designee to the beneficiary should be noted on the delivery slip 
obtained by the supplier (i.e., spouse, neighbor). The signature of the designee should be legible. If the 
signature of the designee is not legible, the supplier/shipping service should note the name of the designee on 
the delivery slip. 
 
For the purpose of the delivery methods noted below, designee is defined as any person who can sign and 
accept the delivery of DMEPOS on behalf of the beneficiary. 
 
The supplier should also have on file any documentation containing a description of the item delivered to the 
beneficiary to determine the accuracy of claims coding including, but not limited to, a voucher, invoice or 
statement in the supplier records. A description of the items(s) delivered must be noted on the POD. The 
description can be either a narrative description (e.g., lightweight wheelchair base), a HCPCS code, the long 
description of a HCPCS code, or a brand name/model number. 
 
POD documentation must be available to the Medicare contractor on request. All services that do not have 
appropriate POD from the supplier will be denied and overpayments will be requested. Suppliers who 
consistently fail to provide documentation to support their services may be referred to the Office of Inspector 
General (OIG) or the National Supplier Clearinghouse for investigation and/or imposition of sanctions. As a 
general Medicare rule, the date of service shall be the date of delivery. There are three methods of delivery. 
Regardless of the method of delivery, the contractor must be able to determine that the item(s) delivered are the 
same item(s) submitted for Medicare reimbursement and that the item(s) were received by a specific 
beneficiary: 
 
Delivery directly to the beneficiary or authorized representative 
Delivery via shipping or delivery service 
Delivery of items to a nursing facility on behalf of the beneficiary 
 
You can find this information in Local Coverage Article Standard Documentation Requirements for All Claims 
Submitted to DME MACs (A55426). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.