Detailed Written Order Requirements
In order to provide orthotic or prosthetic services a detailed written order (DWO) first needs to be obtained from the physician. According to Medicare/Medicaid guidelines the following items need to be included on the DWO.
- PATIENT'S NAME
- PHYSICIAN'S NAME
- DATE OF THE ORDER
- DETAILED DESCRIPTION OF THE ITEM
- MEDICAID NUMBER IF PATIENT IS MEDICAID PATIENT
- FUNCTIONAL LEVEL (K-0 THROUGH K-4) **Only Prosthetics**
- TYPE OF FITTING (CUSTOM FIT OR CUSTOM FABRICATED) **Only Orthotics**
- DIAGNOSIS CODE
- AFFECTED SIDE
- PHYSICIAN SIGNATURE & DATE
**SIGNATURE AND DATE STAMPS ARE NOT ALLOWED
**INSURANCE REQUIRES LEGIBLE PHYSICIAN SIGNATURE OR SIGNATURE LOG MUST BE COMPLETED
Someone other than the prescribing physician can write the DWO, however, the prescribing physician must review the order and sign and date the document.