The Standard Written Order & Written Order Prior to Delivery

The Issue:

Before submitting a claim for any prosthetic or bracing (orthotic) device, a supplier must have a Standard Written Order. In addition, some prosthetic or bracing devices require a Written Order Prior to Delivery, which is a SWO completed before the item is delivered. What exactly is a SWO? And which devices require a WOPD?

What You Need to Know:

The SWO must contain all the following elements:

1. Beneficiary’s name or Medicare Beneficiary Identifier;
2. Order date (ideally, the date the treating practitioner first communicated the order to the supplier);
3. A general description of the item (e.g., general description, HCPCS code(s), HCPCS descriptor(s), or brand name/model number);
4. Quantity;
5. Treating practitioner’s name or National Provider Identifier; and
6. Treating practitioner’s signature. Signature stamps and date stamps are not allowed.

Bracing (orthotic) devices described by the following L-codes require a WOPD:

L0648 / L0650 / L1832 / L1833 / L1851 / L3960 / L0631 / L0637 / L1843 / L1932 / L1940 / L1951 / L1960 / L1970 / L2005 / L2036 / L0648 / L0650 / L1832 / L1833 / L1851

Prosthetic devices described by the following L-codes require a WOPD:

L5856 / L5757 / L5858 / L5973 / L5980 / L5987

What This Means for You:

There are three things key takeaways for you to integrate these requirements into your practice. First, you must understand which prosthetic and bracing (orthotic) devices require a SWO on the one hand and a WOPD on the other. As noted above, while the 6 elements listed above are identical for both, the WOPD – as the name implies – must be completed before the supplier delivers the item. Second, a WOPD requires a face-to-face visit between the beneficiary and the prescriber within the preceding 6 months. Third, make sure to cross reference the list of codes above with your practice management software so that it flags those instances where a WOPD is required. Failure to comply with these requirements will result in a claim denial that will be exceedingly difficult to reverse on appeal.