Why does the doctor have to be in the office to dispense DME?

CMS has punted this issue to the individual states and territories, each of which have their own practice boards covering various professions. Thus in certain states (majority) where there are few or no boards governing DME practices, there are no limits. In other states, there are signficiant restrictions.

The best way to find this is to research this on one of the two National Provider Enrollment websites. Using NPE West as an exampe, (https://www.palmettogba.com/palmetto/npewest.nsf)

One can search their licensure database for all fifty states and territories for every conceivable family of DME by searching the licensure database tab at the bottom of the page (https://www.palmettogba.com/palmetto/npewest.nsf/DID/P4LF7PNQM8?Open).

One merely has to click on a particular state and then the category of DME.

Using Texas (a licensure state) as an example, the data base states:

Custom-made or custom-fitted items must be provided by a “Licensed Prosthetist” or “Licensed Orthotist/Prosthetist” in a State licensed “Accredited Facility. The Texas O&P statute exempts certain license holders: (1) a podiatrist practicing under Chapter 202; (2) a chiropractor practicing under Chapter 201; (3) an occupational therapist practicing under Chapter 454; or (4) a physical therapist practicing under Chapter 453. A Board for Certification (BOC) Pedorthist’s scope of practice is limited to below the ankle. A pharmacist licensed by the Texas State Board of Pharmacy or a person who is working under the direct supervision of a pharmacist may practice orthotics.

Note E: The Texas O&P Board issued a statement that any individual who custom fits a diabetic or other shoe through means of moldable inserts or other methods, regardless of where the final shoe is manufactured, is practicing orthotics per Sections 605.002 (3), (4), (12), and (14).and must either be licensed under the Texas Orthotics and Prosthetics Act or exempt. Exemptions include only physical therapists, occupational therapists, chiropractors, podiatrists, pharmacists, and certified pedorthists who provide devices that affect the anatomical ankle and below. With the exception of certified pedorthists, the listed professionals may operate and provide orthotic devices under the auspices of their own Acts as defined in state law.

Because you are supposed to heat mold the A5512 and also do the same for the custom ones (A5513/14) if needed, the person perfroming these tasks must be licensed. Because your medical assistant who is not licensed under any of the state board requirements they cannot dispense shoes or inserts as it is practicing without a license.

How this is policed is beyond me, but you just never know which employee may wish to be a qui tam and be a whisteblower. MCR could also ask for your work logs and see you were performing sx in an ASU or hospital or you were in a SNF on the day the shoes were fit.

In case of a medical malpractice claim, you could also be held responsible for allowing an untrained unlicensed individual to work on your behalf.

There are many examples for every state to explore. I am only providing one.

That being said the database does sometime have hiccups, but this also the database the enrollment caseworkers use when reviewing your application(s). There have been cases where the wrong information is entered into the state database thus interfere with applications being proessd properly. But these are rare. If this should happen to you, one should report this to your enrollment specialist who may be able to resolve this. But again these are rare.

I hope this answers your question.