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
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
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.
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
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.
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.
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
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
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.
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.