Durable medical equipment (DME) is equipment that is primarily and customarily used to serve a medical purpose, can withstand repeated use, and is appropriate for use in the home. Some examples of DME include hospital beds, walkers, wheel chairs and oxygen tents.
Medical supplies of an expendable nature, such as bandages, rubber gloves and irrigating kits are not considered by Medicare to be DME.
Medicare only covers DME if it is necessary and reasonable for the treatment of an illness or injury, or to improve the functioning of a malformed body member. Medicare does not routinely cover air conditioners, dehumidifiers, and several other supplies that it considers to be not primarily medical in nature. Though often crucial to a patient's well being, these supplies are considered to be convenience items which may be useful to a beneficiary in the absence of illness or injury. However, coverage for many of these items can be granted by an Administrative Law Judge if your doctor certified they are medically necessary. Be sure to ask your doctor if the DME your doctor has recommended for you is an item normally covered by Medicare.
Medicare will not pay for the purchase of DME valued at over $150 all at once. Instead, Medicare makes monthly rental payments during the period of medical need. These payments usually equal 10% of the purchase price of the DME and may not exceed a period of 15 months. After 15 months of continuous rental, a beneficiary is considered to own the equipment.
You must have your doctor prescribe the equipment for you and certify that it is medically necessary in order to get Medicare coverage. Your doctor must complete the DME Medical Necessity form. You may obtain this form from your physician or from your local Medicare office. This form must be submitted to Medicare along with your DME claim. DME suppliers, rather than the beneficiaries, must submit the claims paperwork to Medicare.
Medicare determines the maximum rate it will consider for payment for each piece of DME, known as the "approved amount." Medicare then pays 80% of that approved amount.