Letter of Medical Necessity vs. Prescription

There are thousands of FSA eligible expenses out there, for some of these items, the IRS requires supporting documentation be submitted to your FSA administrator along with a copy of your receipt. We know it’s not always easy to discern which kind of supporting documents you need; a letter of medical necessity (LOMN) or a prescription from a physician but hopefully this short guide will help.
 
First, what is the difference between a LOMN and a prescription?
 
  • Letter of Medical Necessity: a document filled out by a physician stating the service or product necessary to treat a diagnosed medical condition. Proficient Benefit Solutions has a LOMN form that you can take to your doctor to be filled out and returned to us with your receipt. Download the form here!
  • Prescription: as defined under IRS Notice 2010-59 “written or electronic order that satisfies the legal requirements for a prescription in the state in which the expense is incurred.” If a doctor gives a general recommendation for medical care (LOMN) without providing an actual prescription, the administrator is not permitted to accept the claim or Receipt Review.
A general rule to follow when trying to decide if you need a LOMN or prescription is if the over-the-counter (OTC) item you are attempting to purchase is ingestible (e.g. Vitamin D supplements, Pain Relievers, Antacids, etc.) you will need a prescription.
 
Deciding if an item or procedure will need a letter of medical necessity is a little trickier as there isn’t a simple answer; whether or not an item or service will require a LOMN can vary by circumstance.  If an item or service can ONLY be used for medical care (e.g. wheelchairs, vaccines, bandages, x-rays, etc.) they will not require a LOMN. However, if an item or procedure could be used in a way that IS NOT medical, or may be considered cosmetic, a LOMN will be required (e.g. massage therapy, orthopedic shoes, nutritionists, etc.).
 
The great news is that many OTC items do not require a prescription or a LOMN! Check out our eligibility list for just a small sample of qualified expenses.
 
We understand that this can all be confusing, if you ever need to check on what is required for an item or service you are ready to purchase don’t hesitate to call us: 210.659.8100.
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