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When Step 4 is met, further evidence review is not necessary

However, with this order documented in the medical record, after the therapist evaluates the patient and establishes the plan of treatment, based on the evaluation's findings, the therapist forwards the patient's plan of treatment back to the referring physician/NPP to obtain a dated signature for the same patient with the same diagnosis to meet coverage and payment conditions to satisfy the initial certification requirementcreating an administrative burden for both the physician/NPP and the therapist

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( Based on these considerations, CMS believes that, to capture an accurate rebate amount and consistent with reconciliations of pricing data submitted to CMS that provide for revisions when necessary due to errors, including mathematical errors, and manufacturer misreporting, certain circumstances merit reconciliation of the rebate amount separate from the 12-month and 36-month reconciliations proposed at 428.401(d)(1)

Over time, the strength and dosage are reduced