DME claims stall for a short list of reasons, and most of them are settled before the claim goes out: an order missing an element, no signed proof of delivery, a face-to-face visit or prior authorization Medicare needed before delivery, the wrong modifier for a rental month, or a claim sent to the wrong contractor. Get those right and a clean electronic Medicare claim is paid on Medicare's own schedule: no sooner than the 14th day after it's received, and within 30 days (Medicare Claims Processing Manual, ch. 1 §80.2).
Below is each cause, what Medicare requires and what you can check before you bill. Medicaid and commercial plans set their own rules, so check each payer's policy too.
What has to be on file, and when
Record | What Medicare needs | When |
|---|---|---|
Standard written order (SWO) | Six elements, signed by the treating practitioner | Before the claim; before delivery for listed items |
Face-to-face encounter | A practitioner visit within six months before the order, documented | Before the order, for listed items |
Prior authorization | An affirmed decision | Before the item is furnished, for listed items |
Proof of delivery | Signed by the patient or their designee | At delivery; kept for seven years |
Medical record | Shows the coverage criteria in the item's policy | Before the claim |
1. An order missing an element
Medicare replaced the detailed written order (DWO) with the standard written order (SWO) for dates of service from January 1, 2020. It must show the patient's name or Medicare number, a description of the item, the quantity where it applies, the treating practitioner's name or NPI, the order date and the practitioner's signature, and it must be in hand before you submit the claim (CMS, DMEPOS order requirements). The treating practitioner doesn't have to be a physician.
The usual gaps are an unsigned or undated order, a description too vague to match the HCPCS code, or no quantity on a supply order. Check at intake: the six elements, and that the item ordered is the item you're delivering.
2. A face-to-face visit and order needed before delivery
For items on CMS's Required Face-to-Face Encounter and Written Order Prior to Delivery List, two more things apply. The treating practitioner must have seen the patient within the six months before the order, and the visit must be documented in the record. The complete order must also reach you before delivery, not just before billing (same CMS page).
This one can't be fixed afterward: an order dated after delivery doesn't cure a listed item. CMS has added items to this list during 2026, so check every HCPCS code against the current list rather than relying on memory.
3. Prior authorization Medicare required
For items on Medicare's Required Prior Authorization List, prior authorization is a condition of payment. The list covers power mobility devices, pressure-reducing support surfaces, certain orthoses, lower limb prosthetics, pneumatic compression devices and a manual wheelchair base, and CMS added codes to it in 2026 (CMS, prior authorization for certain DMEPOS items). Most DME isn't on it.
The request goes to the DME contractor before the item is furnished, and a listed item delivered without an affirmed decision isn't payable. Medicaid and commercial plans keep their own lists. Check at intake: look up each code on the payer's current list, and don't schedule delivery of a listed item until the decision is on file.
4. Proof of delivery missing or incomplete
Medicare's own denial reasons for DME include no proof of delivery, a missing or illegible signature, a missing patient name or delivery address, and a signature date that doesn't match the date of service (CMS generic DME reason codes). When you deliver directly, the date of service is the delivery date. When you ship, the shipping date can be the date of service, and your records must link the package to the delivery service's tracking.
Proof of delivery has to be kept for seven years from the date of service, whatever the delivery method (CMS, DME proof of delivery requirements). Check before billing: name, address, item and quantity, date and signature, all present and legible.
5. The wrong modifier
DME modifiers say how an item was supplied and what the record shows:
Modifier | Meaning |
|---|---|
NU | New equipment, purchased |
UE | Used equipment, purchased |
RR | Rental |
KH | Capped rental, first month |
KI | Capped rental, second and third months |
KJ | Capped rental, months four to thirteen |
KX | The item's coverage criteria are met and documented |
GA | A signed advance beneficiary notice is on file |
GY | The item isn't a Medicare benefit |
Capped rental items, such as hospital beds and many wheelchairs, are paid monthly for up to 13 continuous months, after which the patient owns the item (42 CFR 414.229). The supplier doesn't choose when to convert a rental to a purchase. Claims go each month with RR and the month's modifier, and the usual errors are a month billed with the wrong modifier, a capped item billed as a purchase, or KX added when the record doesn't show the criteria. The DME billing page has a tool to "Follow a capped rental" month by month.
6. Same or similar equipment
Medicare denies an item when the patient already has the same or similar equipment within its reasonable useful lifetime, usually five years. A patient who changed suppliers or moved may not mention it. Check before delivery: run a same-or-similar check on the DME contractor's portal along with eligibility. Our eligibility verification page shows, in "What a check before the visit covers", what a full check includes.
7. CMNs and DIFs: the forms went, the information didn't
Medicare stopped using certificates of medical necessity (CMNs) and DME information forms (DIFs) for dates of service from January 1, 2023 (CMS). What they recorded, such as an oxygen patient's test results, still has to be in the medical record, and KX on the claim says it is.
8. The claim went to the wrong DME contractor
Medicare DME claims go to one of four DME Medicare Administrative Contractors (Jurisdictions A, B, C and D), chosen by the patient's permanent address, not by where you are or where the item was delivered (CMS, who are the MACs). Noridian holds Jurisdictions A and D, and CGS holds B and C. For example, a patient who lives in New York and winters in Florida is billed to Jurisdiction A, wherever the equipment was delivered.
When an additional documentation request arrives
If a claim is picked for prepayment review, the contractor sends an additional documentation request (ADR). You have 45 calendar days to send the records, with no extensions, and a claim whose records haven't arrived by day 46 is denied (CMS transmittal 567). Send the whole file at once: the order, the face-to-face notes where they apply, proof of delivery, and the records that show the coverage criteria.
Frequently Asked Questions
How long does it take to get paid for DME claims?
Medicare pays a clean electronic claim no sooner than day 14 after it's received and within 30 days. Other payers set their timing by contract and state prompt-payment law. Claims that stall usually do so for one of the reasons above.
What is the most common reason DME claims get denied?
Many DME denials trace back to the record: an incomplete order, missing proof of delivery, or notes that don't show the coverage criteria in the item's policy. Modifier errors and same-or-similar equipment are the next things to check.
Does Medicare require prior authorization for all DME?
No. Medicare requires it only for items on its Required Prior Authorization List, such as power mobility devices and some orthoses. The list grows, so check the current CMS list before delivery.
Can I bill DME as a rental and later convert it to a purchase?
Not by choice. Many items follow Medicare's capped rental rules: monthly rental payments for up to 13 continuous months, after which ownership passes to the patient. Billing a capped rental item as an outright purchase is a common cause of denials.
How can a DME billing company help?
A billing team can code each item with its HCPCS code and modifiers, check orders and proof of delivery before claims go out, send rental claims each month, and work denials and open claims. Gathering the clinical records and prior authorization still sits with the supplier and the prescriber.
Where Beeline fits
Beeline is a US company with a dedicated billing team that bills for DME suppliers: HCPCS codes and modifiers, orders and proof of delivery checked before each claim, rental claims sent each month, and denials and open claims followed up by payer and age. The DME billing page sets out what we handle, and its tool, "Follow a capped rental", shows which modifier each rental month takes. To talk through your own claims, book a free consultation.