Durable Medical Equipment

Homecare Provider since 1980

Durable Medical Equipment (DME) is:

• Durable (is long lasting)
• Used for a medical reason
• Not usually useful to someone who isn't sick or injured
• Used in your home

DME by diagnosis

Covered Durable Medical Equipment includes, but isn't limited to

• Air fluidized beds
• Blood glucose monitors
• Canes (white canes for the blind are not covered)
• Commode chairs
• Crutches
• Home oxygen equipment and supplies
• Hospital beds
• Infusion pumps (and some medicines used in infusion pumps if considered reasonable and necessary)
• Nebulizers (and some medicines used in nebulizers if considered reasonable and necessary)
• Patient lifts (to lift patient from bed or wheelchair by manual or power operation)
• Suction pumps
• Traction equipment
• Walkers
• Wheelchairs

Canes & Crutches

Medicare covers canes and crutches for patients who have trouble walking, but can walk with support. An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor.

Commode Chairs

Medicare covers a commode chair if the patient does not have access to regular toilet facilities because he/she is confined to:

• a single room, or
• a single level without a toilet, or
• a home where there is no toilet

There are additional coverage guidelines for other types of commode chairs and your treating doctor and/or supplier can provide the more detailed coverage criteria for you.

An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor.

Hospital Beds

Medicare covers a hospital bed when the patient cannot use a normal bed because he/she needs to:

• change body positions in ways not possible with a normal bed, or
• be in body positions not possible with a normal bed in order to relieve pain, or
• have the head of the bed higher than 30 degrees most of the time due to illnesses such as congestive heart failure, chronic pulmonary disease, and others, or
• use traction equipment that must be attached to a hospital bed.

These criteria are the basic coverage criteria for hospital beds. There are several different kinds of beds and each has additional requirements. Your treating doctor and/or your supplier can provide more detailed coverage criteria for those items.

An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor.
A Certificate of Medical Necessity must be completed, signed, and dated by the treating doctor.

http://www.cms.hhs.gov/cmsforms/downloads/CMS841.pdf

Manual Wheelchairs

An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor. Also, supporting documentation for the medical need of this item must be on file.

Nebulizer Medicare covers a nebulizer for patients whose ability to breathe is impaired and need this machine to deliver medications that treat certain respiratory problems. Respiratory problems may include chronic bronchitis, emphysema, cystic fibrosis, HIV, organ transplant complications, tracheostomy or other illnesses that cause thick mucous secretions.

An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor.

Medline Freedom Chair - Special Pre-Sale!
http://www.cms.hhs.gov/cmsforms/downloads/CMS8441.pdf 

Note: Medicare does not cover disposable nebulizers; they are considered to be convenience items. Also, Medicare does not cover the nebulizer unless the related medication is covered.

Patient Lifts

Medicare covers a patient lift if a patient cannot move from a bed to a chair, wheelchair or commode without the help of more than one person; the patient would be confined to a bed without the use of a lift.
An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor.

Pressure Reducing Support Surfaces - 1
Medicare covers Group 1 Pressure Reducing Support Surfaces if the patient is bedridden, has limited movement, or has a pressure
A Group 1 Pressure Reducing Support Surface is a mattress or an overlay used to prevent or treat bed sores (pressure ulcers). Medicare will only pay for Group 1 Pressure Reducing Support Surfaces if they are waterproof. An order (prescription) must be on file with the supplier.
It must be signed and dated by the treating doctor.
http://www.cms.hhs.gov/cmsforms/downloads/CMS842.pdf

Pressure Reducing Support Surfaces - 2
Medicare covers Group 2 Pressure Reducing Support Surfaces for patients with certain types of pressure ulcers. Your treating doctor and/or your supplier can provide more detailed coverage criteria.
An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor.
http://www.cms.hhs.ciov/cmsforms/downloads/CMS842.pdf 

Pressure Reducing Support Surfaces - 3
Medicare covers air fluidized beds for patients who have either thick tissue loss or certain types of severe pressure ulcers. Your treating doctor and/or your supplier can provide more detailed coverage criteria.
An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor.
A Certificate of Medical Necessity must be completed, signed, and dated by the treating doctor.
http://www.cms.hhs.gov/cmsforms/downloads/CMS842.pdf

Seat Lift Mechanism

A seat lift mechanism may be covered if a person is not able to stand up from any chair in his/her home. The person must be able to walk, once they reach a standing position.

Note: The fact that a patient has trouble or is unable to get up from a chair, even a low chair, does not justify the need for a seat lift.

The patient must have severe arthritis of the hip or knee or have a severe neuromuscular disease. The seat lift mechanism must be part of the doctor's course of treatment and be prescribed to improve, or prevent deterioration of, the patient's condition.

A seat lift mechanism gently raises and slightly tilts the chair to raise the person from a sitting position to a standing position. Medicare only covers seat lift mechanisms that operate smoothly, can be controlled by the patient and assist the patient in standing up without other help.

Medicare covers only a seat lift mechanism, not the cost of an entire chair.
An order (prescription) for each item billed must be on file with the supplier. It must be signed and dated by the treating doctor.A Certificate of Medical Necessity for Seat Lift (DMERC 07.02A) must be completed, signed, and dated by the treating doctor.
http://www.cms.hhs.gov/cmsforms/downloads/CMS849.pdf

Walkers

Medicare covers a walker for patients who can walk, but need additional support that cannot be provided by a cane or crutch(es).

There are additional coverage guidelines for other types of walkers and your treating doctor and/or your supplier can provide more detailed coverage criteria.

An order (prescription) must be on file with the supplier.
It must be signed and dated by the treating doctor.

Wheelchairs Options & Accessories

Wheelchair options and accessories make a wheelchair more suitable for a person's specific illness, injury or condition. Medicare covers options and accessories for wheelchairs when a patient has a wheelchair that meets Medicare coverage guidelines, and the options or accessories are necessary for the patient to perform normal daily activities.

For an option or accessory for a manual wheelchair to be covered, a written signed and dated order must be received by the supplier before a claim is submitted to the DMERC. If the supplier bills for an item without first receiving the completed order, the item will be denied as not medically necessary. Also, supporting documentation for the medical need of this item must be on file.