The “Dear Physician” Letter, Explained — and Why the Physician's Record Decides Your O&P Claim

The DME MACs wrote a letter to referring physicians because under-documented physician notes sink O&P claims. Here's what it says, and how to act on it.

Policy citations verified against primary sources on July 13, 2026

What a Dear Physician letter is

The four DME MACs jointly publish “Dear Physician” letters — open letters that suppliers can hand to referring physicians explaining exactly what Medicare needs to see in the physician's documentation. The O&P letter, “Documentation of Artificial Limbs and Braces (O&P),” was most recently revised in October 2024.

It exists because of a structural problem every O&P practice knows: the prosthetist writes a thorough evaluation, but the claim is judged first on the referring physician's record — and physicians rarely document to O&P policy requirements without help.

The corroboration rule

Congress made orthotist/prosthetist notes part of the medical record by amending the Social Security Act. But part of the record is not the same as sufficient on its own — the letter is precise about the relationship:

“the O&P supplier's notes are expected to corroborate and provide details consistent with your (physician/practitioner) records”
— DME MAC Dear Physician letter (O&P), rev. October 2024

And when the two conflict, the physician's record governs the review. The practical rule for every O&P claim: your evaluation can add detail, but it cannot substitute for a physician record that independently establishes the need. The letter is also explicit that recording a functional level (K-level) by itself is insufficient — the record must document the functional abilities behind it. See our K-level documentation guide.

Using the letter (and its limits)

Handing a referring physician the MAC letter is the sanctioned way to ask for better documentation — it is Medicare's own voice, not yours. Its limit is that it is generic: it tells the physician what Medicare wants in general, not what is missing for this patient and these codes.

That specific gap is what an addendum request has to close — naming the exact criteria that are unsupported and what an adequate note would establish. That is the job ClaimGrade's physician letters automate: the letter is drafted from the precise criteria that failed the analysis, and can be faxed straight to the referring office.

Turn a failing physician note into a specific, fixable request

ClaimGrade drafts the addendum letter from the exact criteria that failed — educational, professional, and ready to fax.

Request Access

Sources

This guide is educational information for O&P providers — not legal, billing, or medical advice. Medicare policy changes; always confirm requirements against the current LCD, policy article, and DME MAC guidance before making billing decisions. Quotations are from the cited CMS/DME MAC sources.