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(7) enrolled prescribing physician, physician assistant, or advanced practice registered nurse’s signature and order signature date. (f) A prescription order for a prosthetic or orthotic device or service may be part of the certificate of medical necessity, if the certificate of medical necessity includes all of the components of a prescription order as described in (e) of this section. (g) A prescription order for a prosthetic or orthotic device or service, including a certificate of medical necessity serving as a prescription order, will be accepted for not more than one year from the signature date. A backdated order will not be accepted as authorization for an item supplied before the provider receiving a valid prescription order for the item. A retrospective start date for a prescription order, with current day signature, may be considered for service authorization review under 7 AAC 120.210 upon individual medical necessity and if all other state and federal regulatory provisions are met. If a retrospective start date is permitted, the prescription order only be valid for one year from the retrospective start date. (h) The prescribing physician, physician assistant, or advanced practice registered nurse’s hard-copy original or authenticated digital signature must be affixed to the prescription order or the certificate of medical necessity serving as a prescription order. The department will not accept a signature stamp or a copy of a signature as part of a valid prescription order even if affixed to the prescription order by the prescriber. A prescription order or certificate of medical necessity received by means of facsimile, with the prescriber’s signature, may be accepted. (i) A prosthetics and orthotics provider enrolled under this section may request payment, as follows, for the reasonable direct costs of delivering or shipping prosthetics or orthotics incurred by the dispensing provider when using the most cost-effective means:

(1) to be eligible for payment, the following conditions apply:

(A) the recipient resides outside the municipality where the business of the enrolled dispensing provider is located;

(B) the item or service is unavailable from a provider of prosthetics and orthotics enrolled under this section in the municipality in which the recipient resides; and

(C) the item shipping from the manufacturer to the provider is durable medical equipment, prosthetics, orthotics, or unique or specialized replacement parts and for which the final unaltered purchase invoice price exceeds $250;

(2) if the shipping charge submitted by the provider exceeds $50, the claim and supporting documents must include

(A) the recipient’s name;

(B) the address the item was shipped or delivered to;

(C) an itemized list of the products included in the shipment or delivery, to include product name, product identifier, quantity, and serial number, when applicable;