Durable Medical Equipment (DME) (Rev. 1, 10-01-03)

by  Jared Staheli
June 17th, 2015

DME is covered under Part B as a medical or other health service (§1861(s)(6) of the Social Security Act [the Act]) and is equipment that:

a. Can withstand repeated use;

b. Is primarily and customarily used to serve a medical purpose;

c. Generally is not useful to a person in the absence of an illness or injury; and

d. Is appropriate for use in the home.

All requirements of the definition must be met before an item can be considered to be durable medical equipment.

A SNF normally is not considered a beneficiary's home.However, a SNF can be considered a beneficiary's home for Method II home dialysis purposes. See the Program Integrity Manual, Chapter 5, for guidelines on when a SNF may be considered a home.

For detailed coverage requirements (including definitions and discussion) associated with the following DME terms and circumstances see the Medicare Benefit Policy Manual, Chapter 15:

• "Durability"

• "Medical Equipment"

• "Equipment Presumptively Medical"

• "Equipment Presumptively Nonmedical"

• "Special Exception Items"

• "Necessary and Reasonable"

• "Necessity for the Equipment"

• "Reasonableness of the Equipment"

• "Payment Consistent With What is Necessary and Reasonable"

• "Beneficiary's Home"

• "Establishing the Period of Medical Necessity"

• "Repairs, Maintenance, Replacement and Delivery"

• "Leased Renal Dialysis Equipment"

• "Coverage of Supplies and Accessories"

• "Beneficiary Disposal of Equipment"

• "New Supplier Effective Billing Date"

• "Incurred Expense Date"

• "Partial Months-Monthly Payment"

• "Purchased Equipment Delivered Outside the U.S."

For coverage information on specific situations and items of DME, see the Medicare National Coverage Determinations Manual.

 

References:

Durable Medical Equipment (DME) (Rev. 1, 10-01-03). (2015, June 17). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/durable-medical-equipment-dme-26664.html

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)


Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


contact

innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Email:
free demo
request yours today
pricing
for any budget
sign IN
welcome back!

Thank you for choosing Find-A-Code, please Sign In to remove ads.