DME Prescription and Letter of Medical Necessity Checklist

Many medical equipment requests fail because the request is too vague. The family says, "We need a wheelchair." The insurer or DME supplier needs to know what kind, why, for what setting, how often, and what documentation proves the need.

The goal is to make the request specific enough that the next person can process it without guessing.

The prescription should include

• patient name and date of birth
• diagnosis or condition driving the need
• exact equipment requested
• key specifications, such as size, side, accessories, or features
• expected duration of need
• home use, if required by the plan
• provider name, NPI, signature, and date

The clinical note should explain

• what the patient cannot do safely without the equipment
• why the equipment is medically necessary
• why simpler or cheaper alternatives are not enough
• how the item supports activities of daily living
• fall risk, oxygen levels, mobility limits, pain, weakness, wounds, sleep study results, or other relevant findings
• whether the equipment is needed in the home

Examples of stronger requests

Weak: "Patient needs walker."

Stronger: "Patient requires a rollator with seat for safe ambulation in the home due to gait instability, limited endurance, and fall risk. Cane is insufficient because patient requires bilateral support and seated rest breaks."

Weak: "Needs hospital bed."

Stronger: "Semi-electric hospital bed is medically necessary because patient requires frequent repositioning not feasible in an ordinary bed and head elevation due to respiratory symptoms."

Supplier packet checklist

• prescription or written order
• recent visit note
• insurance card or Medicaid ID
• prior authorization form, if required
• supplier quote or HCPCS code, if available
• delivery address and contact person
• repair or replacement history, if replacing equipment

If the request gets stuck

Ask the supplier or plan: "What exact documentation is missing?" Do not accept a vague answer like "not covered" until you know whether the issue is the prescription, provider note, supplier status, prior authorization, medical necessity, or plan exclusion.