Page 137 - Medicare Benefit Policy Manual

Oral Device/Appliance for No DMEPOS Benefit Category--The component that
Neuromuscular Electrical performs the medically necessary function of the device is a
Stimulation of the Tongue smartphone which is useful to an individual in the absence of
Muscle for the Reduction an illness or injury.
of Snoring and Obstructive Final determination established on 09-26-22.
Sleep Apnea, Controlled
by Phone Application

Prescription Digital No DMEPOS Benefit Category--Digital therapies or
Therapy computer software are housed on non-medical devices like
smartphones or computers and the equipment and software
as a whole are not DME.
Final determination established on 09-26-22.

Speech Volume DME--These devices are worn behind the ear and play
Modulation System background noise (multi-talker babble) in the patient’s ear
only when the patient speaks. The noise elicits the Lombard
Effect, automatically increasing the patient’s vocal intensity,
slowing their speech rate, and/or increasing the clarity of
their speech. Final determination established on 09-26-22.

Suction Pump, Home DME--Home suction pumps have been classified as DME
Model, Portable or under the HCPCS since 1984 or earlier. This type of home
Stationary, Electric, for suction pump is used for urine collection or drainage.
Use with External Urine Final determination established on 09-26-22.
Management System

Transcutaneous Electrical DME--These devices are used during sleep for the treatment
Nerve Stimulator for for pediatric attention deficit hyperactivity disorder (ADHD).
Electrical Stimulation of Final determination established on 09-26-22.
the Trigeminal Nerve

Wheelchair Accessory: DME--These items are hardware added to the wheelchair to
Dynamic Positioning absorb the force of a patient’s uncontrollable backward
Hardware for Back jerking motions is classified as DME if necessary for the
effective use of a wheelchair classified as DME.
Final determination established on 09-26-22.

Whirlpool Tub, Walk-In, No DMEPOS Benefit Category--A portable hydrotherapy
Portable unit or whirlpool is useful to individuals in the absence of an
illness or injury for relaxation and soothing sore muscles. Per
section 280.1 of chapter 1, part 4 of the Medicare National
Coverage Determinations Manual, portable whirlpool pumps
are not DME because they are not primarily medical in
nature and are personal comfort items excluded from
Medicare coverage (§1862(a)(6) of the Act).