Your Medicare ID card shows your Medicare Beneficiary Identifier (MBI) — a unique 11-character number Medicare uses to process claims. It replaced the old Social Security-based red-white-and-blue card.

Every DME supplier must verify Medicare eligibility before delivering equipment. Without your Medicare number, the supplier cannot bill Medicare — and the order may be delayed or you may be billed directly.

Medicare mails it to you when you first enroll. If you are enrolling someone else, it goes to the address on file with Social Security.

A signed written order from your doctor (or nurse practitioner, physician assistant, or clinical nurse specialist) specifying exactly what equipment is needed, the diagnosis, and the medical reason. Some equipment also requires a Detailed Written Order (DWO) with more specifics.

Medicare won't pay for DME without a valid physician order. The order documents that the equipment is medically necessary for your loved one's specific condition — not just convenient.

The treating physician who knows the patient's condition — not just any doctor. For complex equipment (power wheelchairs, CPAP, oxygen) it must be the physician managing that specific condition.

A standardized Medicare form completed and signed by the physician that certifies specific medical criteria are met. CMNs are required for oxygen equipment (Form 484.02), power mobility devices (Form 484.03), and certain other complex DME. Each CMN form is tied to a specific type of equipment.

Medicare requires CMNs to verify that patients meet objective medical criteria — not just a physician's general opinion. For oxygen, it documents blood oxygen levels. For power wheelchairs, it documents mobility limitations. Missing or incomplete CMNs are one of the top reasons Medicare claims are denied.

The ordering physician completes and signs the CMN. Some suppliers provide the blank form; others submit it directly. The physician must have clinical knowledge of the patient — they cannot sign a CMN they did not fill out.

ICD-10 codes are standardized medical codes that describe the patient's diagnosis. Examples: J44.1 = COPD with acute exacerbation (often required for oxygen); G47.33 = Obstructive Sleep Apnea (required for CPAP); M79.3 = Panniculitis (sometimes used for bariatric equipment). The code must match the equipment being ordered.

Medicare uses ICD-10 codes to verify that the equipment is appropriate for the documented medical condition. A mismatch between diagnosis code and equipment type is an automatic denial. For example, an order for CPAP equipment must include a sleep apnea diagnosis code — not just a general 'difficulty sleeping' code.

The ordering physician includes ICD-10 codes in the written order. If you're unsure what codes apply, ask the doctor's office specifically: "What ICD-10 diagnosis codes should go on the order for [equipment]?"

Prior authorization is advance approval from Medicare (or a Medicare Advantage plan) that the equipment is covered BEFORE delivery. It's required for power wheelchairs, power scooters, and certain high-cost respiratory equipment. Without PA, delivery of these items often results in a denied claim — and you could be responsible for the full cost.

For power mobility devices, Medicare requires PA because these are high-cost items with historically high fraud rates. If a supplier delivers a power wheelchair without PA approval in hand, and the PA is later denied, the supplier typically cannot bill Medicare — and may be legally prohibited from billing you either. But some suppliers will try.

The DME supplier initiates the PA request after receiving the physician order and clinical documentation. PA is submitted to Medicare or the Medicare Advantage plan (each MA plan has its own PA rules). Approval typically takes 1–14 business days.

A documented in-person clinical evaluation by the ordering physician within a required timeframe before the order is written. For power wheelchairs: within 45 days before the order date. For oxygen: typically within 30 days. The physician's notes must document the medical findings that justify the equipment.

Medicare requires face-to-face evaluations to prevent 'prescription mills' — situations where doctors sign orders without actually examining patients. The evaluation must be documented in the medical record, and those records may be requested during a Medicare audit.

The ordering physician (or NP/PA/CNS acting within their scope). Telehealth visits may qualify for some equipment types — ask the supplier whether a telehealth visit satisfies the face-to-face requirement for your specific equipment.

A polysomnography (in-lab sleep study) or home sleep test (HST) that documents the patient's Apnea-Hypopnea Index (AHI). Medicare requires an AHI of 15 or more, OR an AHI of 5–14 with documented symptoms (excessive daytime sleepiness, insomnia, hypertension). The study must be interpreted by a qualified physician.

CPAP is one of the most audited DME categories. Without a qualifying sleep study with specific AHI values documented, Medicare will deny coverage. The study results must be on file with both the ordering physician and the DME supplier.

The sleep study is ordered by the treating physician and performed at a sleep lab or at home (home sleep test kit provided by lab or physician). Results are interpreted by a sleep specialist or the ordering physician.