Page 123 - Medicare Benefit Policy Manual

constitutes medical equipment. This development would include the advice of local
medical organizations (hospitals, medical schools, medical societies) and specialists in
the field of physical medicine and rehabilitation. If the equipment is new on the market,
it may be necessary, prior to seeking professional advice, to obtain information from the
supplier or manufacturer explaining the design, purpose, effectiveness and method of
using the equipment in the home as well as the results of any tests or clinical studies that
have been conducted.

1. Equipment Presumptively Medical

Items such as hospital beds, wheelchairs, hemodialysis equipment, iron lungs, respirators,
intermittent positive pressure breathing machines, medical regulators, oxygen tents,
crutches, canes, trapeze bars, walkers, inhalators, nebulizers, commodes, suction
machines, and traction equipment presumptively constitute medical equipment.
(Although hemodialysis equipment is covered as a prosthetic device (§120), it also meets
the definition of DME, and reimbursement for the rental or purchase of such equipment
for use in the beneficiary’s home will be made only under the provisions for payment
applicable to DME. See the Medicare Benefit Policy Manual, Chapter 11, “End Stage
Renal Disease,” §30.1, for coverage of home use of hemodialysis.) NOTE: There is a
wide variety in types of respirators and suction machines. The DME MACs medical staff
should determine whether the apparatus specified in the claim is appropriate for home
use.

2. Equipment Presumptively Nonmedical

Equipment which is primarily and customarily used for a nonmedical purpose may not be
considered “medical” equipment for which payment can be made under the medical
insurance program. This is true even though the item has some remote medically related
use. For example, in the case of a cardiac patient, an air conditioner might possibly be
used to lower room temperature to reduce fluid loss in the patient and to restore an
environment conducive to maintenance of the proper fluid balance. Nevertheless,
because the primary and customary use of an air conditioner is a nonmedical one, the air
conditioner cannot be deemed to be medical equipment for which payment can be made.

Other devices and equipment used for environmental control or to enhance the
environmental setting in which the beneficiary is placed are not considered covered
DME. These include, for example, room heaters, humidifiers, dehumidifiers, and electric
air cleaners. Equipment which basically serves comfort or convenience functions or is
primarily for the convenience of a person caring for the patient, such as elevators,
stairway elevators, and posture chairs, do not constitute medical equipment. Similarly,
physical fitness equipment (such as an exercycle), first-aid or precautionary-type
equipment (such as preset portable oxygen units), self-help devices (such as safety grab
bars), and training equipment (such as Braille training texts) are considered nonmedical
in nature.

3. Special Exception Items