Specific Coverage Requirements for DME
Most durable medical equipment has specific eligibility requirements. For example, a bedside commode is covered only if the person is bed-or room-confined. In some instances, coverage of certain DME items will not be covered simultaneously. A wheelchair and a walker will be not covered at the same time, and a seat lift mechanism that helps a person exit a chair will not be covered if a person uses a wheelchair.
To learn more about the exact criteria that a person must meet in order to qualify for a specific item, please visit the website of New York's regional Medicare carrier, HealthNow NY, at http://www.umd.nycpic.com/index2.html. After logging onto the site, 1. Click on DMERC A; 2. Click on Suppliers Manual under the heading Providers; and 3. click on Chapter 14, Equipment. For additional information, review the DME Reference List under the Beneficiaries Section of HealthNow's website.
Physician's Prescription
All items submitted for Medicare payment require a doctor's prescription, also referred to as a Certificate of Medical Necessity (CMN). To learn more about a CMN, please visit the website of New York's regional Medicare carrier, HealthNow NY, at http://www.umd.nycpic.com/index2.html. After logging onto the site, 1. Click on DMERC A; 2. Click on Suppliers Manual under the heading Providers; and 3. click on Chapter 12.
Covered items for eligible patients
- Alternating Pressure Pad
- Bead Bath
- Bed Pan
- Cane
- Commode
- Heating Pad
- Heat Lamp
- Hospital Bed
- Mattress (covered only with hospital bed)
- Mobile Geriatric Chair
- Pressure Relieving Surfaces (pads & mattresses)
- Seat Lift
- Sitz Bath & Whirlpool Bath Equipment
- Trapeze Bar
- Walker
- Wheelchair (manual & powered)
Noncovered items for eligible patients
- Air cleaner
- Augmentative Communication Device
- Bathtub Lift
- Bathtub Seat & Transfer Bench
- Bed Bath
- Environmental Control Equipment
- Grab Bar
- Overbed Table
- Stair Lift
- Telephone Alert System
- Toilet Safety Frame
- Toilet Seat
- Whirlpool Pump
