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:

• Pub 100-04 Medicare Claims Processing Manual