Currentpriority healthPolicy N/A

DME Refill Requirements

Defines supplier requirements for refilling durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), including contact, documentation, quantity limits, and delivery timing; applies to providers and suppliers under Priority Health (Medicare guidance referenced).

Policy Summary

Payerpriority health

PolicyDME Refill Requirements

Policy CodePolicy N/A

Change TypeAdministrative edits

Effective DateN/A

Next Review DateMar 20, 2026

Key ActionSupplier must contact the patient to confirm a refill is needed before dispensing; do not automatically ship refills.

SourceLink

POLICY UPDATE CHANGES

Reviewed, removed 'applies to section' and updated 'Disclaimer' section.

1 monthmax dispense: specified items

3 monthsmax dispense: other recurring refills

10 daysearliest delivery

30 daysdocumentation window

DMEPOS Refill Requirements

Refill limits, delivery timing, contact and documentation

Operational refill limits and documentation requirements for suppliers:

ALL of the following

ALL of the following
- For enteral and parenteral nutrients and supplies, immunosuppressive drugs, intravenous immune globulin (IVIG), oral anti-cancer drugs, oral antiemetic drugs, and surgical dressings, suppliers may dispense only a one-month quantity at a time.
- For all other recurring refills, suppliers may dispense no more than a three-month supply at any one time.
ALL of the following
- Supplier must deliver the DMEPOS product no sooner than 10 calendar days prior to the expected end of the current supply.

Policy Summary

Payerpriority health

PolicyDME Refill Requirements

Policy CodePolicy N/A

Change TypeAdministrative edits

Effective DateN/A

Next Review DateMar 20, 2026

Key ActionSupplier must contact the patient to confirm a refill is needed before dispensing; do not automatically ship refills.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

ALL of the following

Supplier must contact the patient (or representative) to confirm that a refill is needed; do not automatically ship refills on a predetermined schedule.

ALL of the following

Evidence that the patient or their representative confirmed need within 30 calendar days from the expected end of the current supply.
For shipped items, documentation must include: patient name, date of contact, item requested, confirmation from the patient, and explanation of the need for the refill.
For in-person retail items, ONE of the following is acceptable
- Delivery slip signed by the patient or their representative.
- Copy of the itemized sales receipt.

Operational note: A provider may write orders including refills, but the supplier remains responsible for contacting the patient to confirm need before dispensing; automatic shipments are prohibited.

Coding and Dispense Quantities

coding and billing standardsmixed

No codes listed

inv-03: max_dispense_quantity

One-month max dispenseFor enteral and parenteral nutrients and supplies, immunosuppressive drugs, intravenous immune globulin (IVIG), oral anti-cancer drugs, oral antiemetic drugs, and surgical dressings, suppliers may dispense only a one-month quantity at a time.

Three-month max dispense for other recurring refillsFor all other refills provided on a recurring basis, suppliers may dispense no more than a three-month supply at any one time.

Earliest allowed refill deliverySupplier must deliver the DMEPOS product no sooner than 10 calendar days prior to the expected end of the current supply.

Authorization and Pre-Service Determinations

Prior Authorization

Pre-Service Organization Determination and Authorization Note

For Medicare indications that do not meet criteria of a National Coverage Determination (NCD), local Coverage Determination (LCD), or a specific medical policy, a Pre-Service Organization Determination (PSOD) must be completed. See the Priority Health Provider Manual for detailed PSOD instructions and submission requirements. Note that a PSOD or authorization does not guarantee payment — billing, coding, documentation and medical necessity requirements (including applicable CMS/MDHHS guidance) must still be met.

Applies when NCD/LCD or specific medical policy criteria are not met
Complete a Pre-Service Organization Determination (PSOD) per the Provider Manual
Authorizations do not supersede coding, billing, documentation, or medical necessity rules
Follow CMS and MDHHS guidance where applicable

Supplier Refill Process

inv-05: Refill order process

Patient contact required prior to refillBefore refilling orders for DMEPOS products, suppliers must contact the patient to make sure a refill is needed.

Provider may include refills on ordersA provider may determine ongoing needs and write an order for DMEPOS for immediate use and refills for later dates.

Automatic shipments prohibitedSuppliers must not automatically ship a refill on a pre-determined basis.