Medicare_Benefit_Policy_Manual / Chapter_15 / 110.1

Why This Topic Matters

Understanding how Medicare defines and evaluates DME is important for determining whether equipment falls within covered benefit categories and whether payment considerations apply in a given setting.

Article Sections

1. Definition of Durable Medical Equipment

   Introduces the basic Medicare definition of durable medical equipment and the overarching criteria used to assess items under this policy.

2. A - Durability

   Discusses the durability concept and the types of items generally treated as non-durable or categorized elsewhere.

3. B - Medical Equipment

   Covers the general policy for determining whether equipment is medical in nature and the kinds of development that may be considered.

4. 1. Equipment Presumptively Medical

   Lists categories of equipment that are generally treated as medical equipment for policy purposes and notes related cross-references.

5. 2. Equipment Presumptively Nonmedical

   Describes broad categories of equipment that are generally not considered medical equipment because of their customary nonmedical use.

6. 3. Special Exception Items

   Summarizes the limited exception category for certain items that may be covered under specific circumstances.

7. C - Necessary and Reasonable

   Addresses the general Medicare requirement that DME be necessary and reasonable for the patient’s condition.

8. 1 - Necessity for the Equipment

   Explains the broad standard used to evaluate whether equipment contributes meaningfully to treatment or improvement.

9. 2 - Reasonableness of the Equipment

   Discusses considerations used to assess whether the item is reasonable for Medicare payment in light of alternatives and cost.

10. 3 - Payment Consistent With What is Necessary and Reasonable

    Addresses payment alignment with medically required features and alternatives that meet the patient’s needs.

11. 4 - Establishing the Period of Medical Necessity

    Covers how the duration of medical necessity is generally determined and points to related review guidance.

12. D - Definition of a Beneficiary’s Home

    Explains how Medicare treats a beneficiary’s home for DME rental and purchase purposes and discusses institutional settings.