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:
• "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.