Page 122 - Medicare Benefit Policy Manual

20, “Durable Medical Equipment, Surgical Dressings and Casts, Orthotics and Artificial
Limbs, and Prosthetic Devices,” for a detailed description of payment rules for each
classification.

Payment may also be made for repairs, maintenance, and delivery of equipment and for
expendable and nonreusable items essential to the effective use of the equipment subject
to the conditions in §110.2.

See the Medicare Benefit Policy Manual, Chapter 11, “End Stage Renal Disease,” for
hemodialysis equipment and supplies.

110.1 - Definition of Durable Medical Equipment
(Rev. 10880, Issued: 08-06-21, Effective: 11-08-21, Implementation: 11-08-21)

Durable medical equipment is equipment which:

• Can withstand repeated use;

• Is primarily and customarily used to serve a medical purpose;

• Generally is not useful to a person in the absence of an illness or injury; and

• 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.

The following describes the underlying policies for determining whether an item meets
the definition of DME and may be covered.

A. Durability

An item is considered durable if it can withstand repeated use, i.e., the type of item that
could normally be rented. Medical supplies of an expendable nature, such as incontinent
pads, lambs wool pads, catheters, ace bandages, elastic stockings, surgical facemasks,
irrigating kits, sheets, and bags are not considered “durable” within the meaning of the
definition. There are other items that, although durable in nature, may fall into other
coverage categories such as supplies, braces, prosthetic devices, artificial arms, legs, and
eyes.

B. Medical Equipment

Medical equipment is equipment primarily and customarily used for medical purposes
and is not generally useful in the absence of illness or injury. In most instances, no
development will be needed to determine whether a specific item of equipment is medical
in nature. However, some cases will require development to determine whether the item