Approval Timelines
How long things
actually take.
The process that should take a week can easily take a month. Knowing what's normal — and what signals a problem — puts you in control of the timeline instead of waiting on it.
Before you look at any timeline
A prescription or order starts the clock. It does not end it.
When a physician writes an order for equipment, medication, or a service, that order is a clinical decision — not an approval. The order triggers a separate administrative and coverage process that the physician does not control and that the patient usually cannot see. Insurance must be verified. Prior authorization may be required. Documentation may need to be supplemented. The supplier or pharmacy must actually have the item. Each of those steps takes time, can encounter delays, and happens largely out of view.
The timelines on this page reflect when that full process runs correctly. They are not guarantees — they are what to expect when each step completes without issues. The most common source of frustration in this system is assuming the order was the finish line when it was actually the starting pistol.
Timeline overview
Find your category. See where it falls.
Click any row to see the step-by-step process, what actually causes delays, and when to escalate.
Same day
1 week
2 weeks
1 month
2 months
3+ months
Days
Weeks
Months
Varies by type
Select a category above to see the step-by-step process
Everyday Equipment
Walkers, hospital beds, CPAP, commodes, and everyday home equipment
Most standard DME arrives within a week when the process runs cleanly. The common delays are not system failures — they're documentation and logistics issues that can often be resolved with a single phone call.
Process working
5–7 days
From order to delivery
What people experience
1–3 weeks
Most actual experiences
CPAP / BiPAP
2–4 weeks
Requires sleep study + prior auth
When it works correctly
5–7 days
Documentation complete, insurance verified, item in supplier inventory, delivery scheduled.
What causes delays
1–3 weeks
Physician order missing diagnosis code
Insurance verification takes 2–3 days
Item not in local inventory
Delivery scheduling gaps
How it works — step by step
Physician
Written order with diagnosis
Physician writes an order specifying the item and diagnosis code. For standard DME this is straightforward — item, diagnosis, brief medical necessity statement. Sent directly to the supplier or given to the patient.
Same day as appointment
DME Supplier
Insurance verification and order processing
Supplier verifies Medicare eligibility, confirms item is covered, checks whether prior authorization is required. For most standard DME, prior auth is not required — supplier bills after delivery.
1–2 business days
DME Supplier
Delivery and setup
Most standard DME delivered to the home. Hospital beds require setup. CPAP requires a respiratory therapist fitting. Medicare pays 80%; Medigap covers the 20%. Most items rented 13 months then become patient property.
1–3 business days after processing
Normal — no action needed
Delivery within 7 days of physician order
Supplier provides a confirmed delivery date
Insurance verification completed within 2 days
Something may be wrong
More than 10 days with no delivery date confirmed
Supplier cannot provide a prior auth reference number
No contact from supplier after order was placed
If it's been more than 10 days
Call the supplier and ask: "What is the current status of my order and what is the expected delivery date?" If they cannot answer in 30 seconds, ask to speak with a supervisor. If health or safety is at risk from the delay, your physician can request expedited processing.
Supply chain and availability. These timelines assume the item is in your supplier's local inventory and that a delivery slot is available. Items sourced from a regional distribution center, backordered products, or deliveries to rural areas where suppliers cover large geographic territories can add 3–7 days to any estimate. If you are in a rural area or your supplier services a wide region, expect the higher end of each range.
Oxygen Equipment
Concentrators, portable units, liquid oxygen systems, and supplies
Oxygen equipment delivers fast — initial setup is typically 1–3 days. The complexity is not the delivery but the ongoing 36-month rental structure and the recertification requirements that control continued coverage.
Initial delivery
1–3 days
From physician order
Rental period
36 months
Then supplier must maintain equipment
Recertification
Month 3 + annual
Physician must document continued need
Initial setup
1–3 days
Blood oxygen documented, order placed, equipment delivered and set up at home by a respiratory therapist.
What causes coverage interruptions
Coverage gap
Recertification not completed at month 3
Annual physician documentation missing
Blood oxygen above threshold at retest
Supplier changes after 36-month period
How it works — step by step
Physician
Document blood oxygen levels and prescribe
Medicare requires documented SpO2 at or below 88% (or PaO2 at or below 55 mmHg) at rest, during sleep, or on exertion. Physician writes a Certificate of Medical Necessity (CMN). The specific oxygen flow rate and system type must be specified.
Same day
DME Supplier
Equipment selection and delivery
Supplier determines the right system — stationary concentrator, portable concentrator, compressed gas, or liquid oxygen — based on the prescription and the patient's activity level. A respiratory therapist delivers and sets up the equipment and trains the patient on its use.
1–3 days from order
Physician
Recertification at month 3 and annually
Medicare requires recertification to confirm continued medical necessity. At month 3, the physician must document that oxygen is still needed. Annually thereafter. Failure to recertify stops coverage — the supplier will notify the patient, but the physician's office must act.
Ongoing obligation
Normal
Equipment delivered within 3 days of order
Monthly supply deliveries arrive on schedule
Supplier proactively contacts physician at month 3
Something may be wrong
Supplier stops deliveries without notice
Recertification letter arrives without physician follow-up
Equipment malfunction with no service response within 24 hours
Wound Care Supplies
Dressings, surgical supplies, and negative pressure wound therapy
Basic wound care supplies deliver within days. Wound VAC (negative pressure wound therapy) requires prior authorization and takes longer — but is still a well-defined process with a predictable timeline.
Basic dressings
1–5 days
Standard gauze and dressings
Advanced dressings
3–7 days
Hydrocolloid, alginate, collagen
Wound VAC
5–14 days
Requires prior authorization
Basic supplies
1–5 days
Physician documents wound type, size, and depth. Supplier ships appropriate dressings. Quantities tied to wound characteristics documented in the order.
Wound VAC delays
5–14 days
Prior authorization review: 5–10 business days
Documentation of wound measurements required
Nurse setup visit must be scheduled
What controls the timeline
Physician
Wound documentation determines what Medicare covers
Coverage for wound care supplies requires documentation of a surgical or debrided wound — not preventive application to intact skin. The physician must document wound type, size, depth, and drainage. Quantities are determined by these characteristics, not by what seems convenient.
Medicare / Insurance
Prior authorization for Wound VAC
Negative pressure wound therapy (wound VAC) requires prior authorization in most cases. Standard review: 5–10 business days. If the wound is deteriorating and delay creates medical risk, the physician can request expedited review — decision within 72 hours.
Normal
Basic supplies arrive within 5 days of order
Wound VAC prior auth submitted same day as order
Monthly resupply delivered on schedule
Something may be wrong
Wound VAC delayed beyond 14 days
Supplier cannot confirm prior auth submission date
Resupply quantities don't match wound documentation
Daily Care Supplies
Ostomy bags, catheters, incontinence supplies, feeding tube supplies, and items you use every day
Some of these supplies are covered by Medicare and delivered monthly. Others — including incontinence supplies — are not covered under Original Medicare. Coverage depends on your plan and your state. The timeline information below applies to the Medicare-covered items in this category.
Initial setup
3–7 days
First delivery and training
Enteral nutrition setup
3–10 days
Formula, pump, and supplies
Monthly resupply
Ongoing
Patient-initiated each month
Incontinence supplies — coverage varies
Briefs, pads, and underpads are not covered under Original Medicare or any Medigap supplement. Some Medicare Advantage plans include them as a supplemental benefit — check your plan's Evidence of Coverage. Medicaid covers incontinence supplies for income-eligible individuals in most states, though the specific products and quantities vary. If you are unsure what your plan covers, call the member services number on the back of your insurance card and ask specifically about incontinence supply benefits.
Initial delivery
3–7 days
Physician documents the specific type and need. Supplier ships appropriate products with instructions. Initial delivery includes training on use.
Ongoing management
Monthly
Patient must request resupply each month
Quantities are capped — cannot stockpile
Product changes require new physician order
What to know about monthly resupply
Patient
You must initiate each monthly order
Medicare does not allow suppliers to automatically ship supplies every month without patient-confirmed need. You or a caregiver must contact the supplier monthly to confirm need and request the resupply. Most suppliers have a phone or online process — keep the supplier's contact information accessible.
DME Supplier
Quantities are tied to documented medical need
The monthly quantity of ostomy, catheter, or enteral supplies is determined by your physician's documentation — not by what you prefer to have on hand. If your needs change, a new physician order is required before the supplier can adjust quantities.
Normal
Initial setup delivered within 10 days of order
Monthly resupply arrives within 5 days of request
Quantities match physician documentation
Something may be wrong
Supplier ships without patient-initiated request
Billing for quantities not received
Supplier changes product without notifying patient
Prescriptions
From same-day generics to multi-week specialty drug approvals
Most prescriptions fill the same day. When they don't, the reason determines the timeline — and knowing which path your medication is on tells you how long it will actually take.
Generic drugs
Same day
Usually no prior auth
Brand with prior auth
3–14 days
Depends on insurer review speed
Specialty drugs
1–4 weeks
Specialty pharmacy + PA required
Generic / Tier 1
Same day
No prior authorization. Pharmacist fills immediately. $0–$15 copay depending on plan and Extra Help status.
What causes delays
Days to weeks
Prior authorization required for brand or high-tier drugs
Step therapy — must try lower-tier drug first
Non-formulary exception request
Specialty pharmacy enrollment required
The four prescription paths
Path 1 — Generic
Same day, no friction
Generic drugs on your plan's tier 1 or tier 2 typically require no prior authorization and fill immediately at the pharmacy counter.
Path 2 — Brand with prior authorization
3–14 days for PA review
Your plan requires the physician to document why the brand drug is medically necessary over lower-cost alternatives. Physician submits documentation. Plan reviews in 3–14 days. If denied, can appeal or request exceptions process.
Path 3 — Specialty drug
1–4 weeks through specialty pharmacy
High-cost specialty drugs are managed by dedicated specialty pharmacies with enrollment requirements. The drug is shipped directly to the patient, not filled at a retail pharmacy. Prior authorization is almost always required. The specialty pharmacy coordinator manages most of the process once enrollment is complete.
Your pharmacist
Can help with most delays
Your pharmacist can run a Medication Therapy Management review at no cost, check for lower-cost alternatives on your formulary, initiate prior authorization with your physician's office, and explain exactly why a claim was rejected and what options exist.
Normal
Generic fills same day at any in-network pharmacy
PA decision within 14 days of submission
Specialty pharmacy contacts you within 48 hours of referral
Something may be wrong
PA submitted but no decision after 14 days
Specialty pharmacy has not contacted you within a week
Claim denied without a clear reason code
Orthotics & Braces
Off-the-shelf and custom-fabricated orthotic devices
Off-the-shelf orthotics arrive in days. Custom-fabricated devices require casting, fabrication, and fitting — a process that takes several weeks even when everything goes correctly.
Off-the-shelf
1–3 days
Standard fit, no fabrication
Custom-fitted
2–3 weeks
Cast or scan, then fabricate
Custom-fabricated
3–6 weeks
Complex custom fabrication
Off-the-shelf brace
1–3 days
Physician order, supplier verifies size and coverage, delivered or picked up at orthotics provider. Standard knee brace, soft ankle brace, off-the-shelf cervical collar.
Custom device delays
3–6 weeks
Physician evaluation and order (1 visit)
Casting or scanning appointment (1 visit)
Fabrication time: 2–4 weeks
Fitting and adjustment appointment
Custom orthotics — the process
Physician
Evaluation and prescription
Physician evaluates the patient, determines the appropriate device type, and writes a prescription specifying the orthosis type and the diagnosis. For custom devices, documentation of why off-the-shelf is insufficient is required.
Orthotist / Supplier
Casting or scanning and fabrication
The certified orthotist takes a cast or digital scan of the affected limb. The custom device is fabricated in a lab — typically 2–4 weeks. For AFOs and KAFOs, the process may involve multiple fitting appointments to achieve correct alignment and comfort.
2–4 weeks fabrication
Normal
Casting appointment scheduled within 1 week
Fabrication completed within 4 weeks
Fitting appointment scheduled promptly after fabrication
Something may be wrong
Casting appointment not scheduled after 2 weeks
No update from orthotist after 4 weeks
Device delivered without a fitting appointment
Compression Garments
Sleeves and stockings for swelling — a Medicare benefit added in January 2024
Lymphedema compression garments became a distinct Medicare benefit in 2024. Standard garments arrive within 1–2 weeks. Custom-fitted garments take 2–4 weeks. Not all suppliers are yet enrolled to bill Medicare for this benefit category.
Standard garments
5–10 days
Off-the-shelf compression
Custom-fitted
2–4 weeks
Measured and fabricated to fit
New benefit — 2024
Verify supplier
Not all suppliers enrolled yet
Standard garments
5–10 days
Physician documents lymphedema diagnosis and prescribes compression class. Supplier ships standard gradient compression sleeves or stockings.
Custom garment delays
2–4 weeks
Certified lymphedema therapist measurement required
Custom fabrication: 1–3 weeks
Supplier must be enrolled in this benefit category
Normal
Supplier confirms they bill Medicare for lymphedema compression
Standard garments delivered within 10 days
Custom garments received within 4 weeks of measurement
Something may be wrong
Supplier says Medicare doesn't cover compression garments
No delivery confirmation after 2 weeks for standard garments
Claim denied — verify supplier enrollment in the 2024 benefit
Power Wheelchairs
Custom power wheelchairs and specialized seating systems — the longest process in the system
Complex Rehab Technology is the most time-intensive category in the system — 45 to 90 days is normal, and everything hinges on the quality of the physician's documentation at step one. The process cannot be rushed at steps 3 through 6.
Best case
45 days
Documentation perfect first time
Typical
60–90 days
Most people's experience
With complications
3–6 months
Documentation requests, appeals
When everything goes right
45 days
Physician documents specific functional limitations. ATP evaluation completed promptly. Prior authorization submitted with complete documentation. Approved first time. Custom manufacturing and delivery.
What causes the most delays
60–120+ days
Vague physician documentation — most common cause
Prior auth denied — documentation request adds weeks
ATP evaluation scheduling delays
Appeals process if initially denied
Six-step process — each step sequential
Physician
Face-to-face examination and specific documentation
The most important step. Physician must document specific functional limitations — not just diagnoses. "Patient has MS with bilateral lower extremity weakness resulting in inability to walk more than 15 feet without falling and inability to propel a manual wheelchair" is what Medicare needs. "Has MS and needs a wheelchair" is not sufficient and will result in denial.
Must be within 6 months of order
ATP — Assistive Technology Professional
Home environment evaluation
A RESNA-certified ATP evaluates the patient in their home environment, assesses mobility needs and home layout, and specifies the exact equipment required including chair type, seating system, and accessories. This evaluation report is a required component of the prior authorization packet.
DME Supplier
Prior authorization packet assembled and submitted
Supplier compiles the complete prior authorization packet: physician order, face-to-face documentation, ATP evaluation, Letter of Medical Necessity, and clinical records. Submitted to the DME Medicare Administrative Contractor (DME MAC) for the patient's geographic region.
2–3 days to assemble and submit
DME MAC — Medicare Contractor
Prior authorization review
Standard review: 10 business days. If the contractor requests additional documentation, the clock resets and the supplier must gather and resubmit. This is the most common source of delay — documentation requests add 2–4 weeks each time they occur.
10 business days + any documentation requests
Manufacturer
Custom manufacturing
Once prior authorization is granted, the wheelchair is custom manufactured to the ATP's specifications. This takes 2–5 weeks depending on the manufacturer and configuration complexity. Standard production wheelchairs at the lower end; fully custom configurations at the higher end.
2–5 weeks
ATP + Supplier
Delivery, fitting, and home adjustment
The ATP delivers the chair and adjusts it to the patient in their actual home environment. This is not a drop-off — proper fitting and adjustment is required to ensure safe use and to meet Medicare's documentation requirements. The 5-year Reasonable Useful Lifetime clock starts at delivery.
Normal at this stage
Prior auth submitted within 2 weeks of ATP evaluation
Supplier provides reference number and submission date
Decision received within 10 business days of submission
Manufacturing update provided after approval
Something may be wrong
Supplier cannot provide prior auth reference number
No decision after 4 weeks — documentation request may be unanswered
Denied — read the reason code before doing anything else
More than 6 weeks with no manufacturing update after approval
The most important thing you can do at every stage
Ask the supplier for the prior authorization reference number. If they cannot provide it immediately, the authorization has not been submitted. Ask what documentation has been requested by the reviewer. Ask when the next action is expected and who is responsible for it. A supplier who cannot answer these questions is not actively managing your case.
ATP availability and geography significantly affect this timeline. Certified Assistive Technology Professionals are not uniformly distributed — in rural areas the nearest ATP may cover multiple counties and have appointment waits of 2–4 weeks. Manufacturing capacity at the wheelchair manufacturer also varies by model and configuration. The 45–90 day range assumes metro or suburban access to an ATP and standard manufacturing capacity. Rural patients and those requiring highly customized configurations should plan for the upper end or beyond.
Artificial Limbs
Prosthetic legs and arms — fitted and built to your body over several weeks
Prosthetic limb timelines range from 4 to 12 weeks depending on the complexity of the device and the patient's K-level classification. The process involves multiple appointments and requires a certified prosthetist.
Simple prosthetic
4–6 weeks
K1–K2, basic function
Complex prosthetic
8–12 weeks
K3–K4, microprocessor components
K-level
Physician sets
Controls what Medicare covers
The process
4–12 weeks
Physician sets K-level. Certified prosthetist evaluates, casts or scans, fabricates the device, provides the initial fit, and adjusts over multiple visits until function is achieved.
What adds time
Varies
K-level dispute — physician and prosthetist must agree
Residual limb changes during healing require refabrication
Prior authorization for high-level components
Multiple fitting adjustments required
Normal
Initial evaluation within 2 weeks of physician referral
Prosthetist provides written timeline after evaluation
Regular fitting appointments scheduled throughout
Something may be wrong
K-level lower than expected — get a second opinion
No update from prosthetist after 6 weeks
Prior auth denied — check the K-level documentation
Also in Supplies & Medications
Equipment & Supplies
Medical Equipment
What qualifies, what's covered, how to get it, and supplier rights.
Equipment & Supplies
Approval Timelines
How long each category actually takes — and what's normal vs. a problem.
Supplies & Medications
Prescriptions & Pharmacy
The four prescription paths, Part D, Extra Help, and what your pharmacist can do.
Supplies & Medications
Retail & Cash-Pay Alternatives
Insurance vs. local retail vs. online — the honest comparison.
Data sources & methodology
Medicare coverage timelines
CMS Medicare Benefit Policy Manual (IOM Pub 100-02) · 42 CFR §414 (DME coverage and billing) · CMS DME MAC processing standards · CMS prior authorization requirements for certain DME (42 CFR §405.924). Timeline ranges reflect CMS standards and real-world processing times reported by DME suppliers and Medicare contractors.
Prior authorization standards
CMS Prior Authorization of Certain Hospital Outpatient Department Services Final Rule · Medicare Advantage prior authorization standards (42 CFR §422.570–422.572) · CMS 2024 MA Prior Authorization Transparency Rule. Expedited review timelines: 72 hours per 42 CFR §422.570(b). Standard review: 14 calendar days per 42 CFR §422.568.
Coverage confidence levels
High confidence: Medicare prior authorization timelines (federal regulation). CMS DME processing windows (CMS published standards).
Moderate confidence: Real-world timeline ranges (reflect supplier and contractor variability — not guaranteed by statute).
Verify directly: Medicare Advantage plan-specific PA timelines · State Medicaid processing windows · Individual DME MAC performance by region.
Moderate confidence: Real-world timeline ranges (reflect supplier and contractor variability — not guaranteed by statute).
Verify directly: Medicare Advantage plan-specific PA timelines · State Medicaid processing windows · Individual DME MAC performance by region.