Medicare_Carriers_Manual / 2105 / 2105._COVERAGE_GUIDELINES_FOR_DURABLE_MEDICAL_EQUIPMENT_CLAIMS.

Why This Topic Matters

DME claims often depend on documentation, site-of-service, and medical-necessity requirements that are handled differently from other Medicare claims. Understanding this manual section helps users identify the documentation and review topics that govern whether a claim needs additional scrutiny.

Article Sections

1. 2105. Coverage Guidelines for Durable Medical Equipment Claims

   Introduces the Medicare coverage framework for durable medical equipment claims and explains the general conditions used in review.

2. Payment may be made for the following

   Covers the broad categories of DME-related expenses addressed in the manual section, including equipment, repairs, maintenance, delivery, and accessories or supplies.

3. DME must be for use in patient's residence other than a health care institution

   Discusses the home-use setting requirement and the types of institutions addressed in the review guidance.

4. Physician's prescription required

   Summarizes the prescription and supporting documentation expectations for DME claims, including special handling for oxygen and related certifications.