What are the requirements for equipment used in the home?
What are the requirements for equipment used in the home?
Medicare Part B helps pay for medical equipment and supplies used in the home, such as oxygen equipment, wheelchairs, artificial limbs, braces, ostomy supplies, and hospital beds. Click here to go to coverages by equipment.
Medicare sets very specific restrictions on the types of services and equipment for which it will pay. One of those is Durable Medical Equipment (DME) under Medicare Part B. DME is defined as equipment that can withstand repeated use, is primarily and customarily used to serve a medical purpose, and is generally not useful to a person in the absence of an illness or injury.
All of the following requirements of this definition must be met before an item can be considered durable medical equipment (it is the role of your physician and your provider to help ensure these requirements are met):
- The equipment is prescribed by a physician
- The equipment meets the definition of medical equipment
- The equipment is necessary and reasonable for the treatment of the patient's illness or injury, or to improve the functioning of a malformed body member
- The equipment is used in the beneficiary's home
- The equipment is a covered service for the beneficiary
Under these requirements, some equipment that patients may find useful and even necessary would not be covered. For example, bathroom safety items such as grab bars are not covered because they are not primarily medical in nature; a new air conditioner is not covered because it does not serve a primarily medical purpose; elevators and other lift devices are not covered because they are useful to people who are not sick or injured.
Home medical equipment must be appropriate for use in the home. A "home" can be a house, an apartment, a relative's house, a home for the aged or some other institutions that are not hospitals.
An institution is not considered a home if it is a:
- hospital or
- primarily engaged in providing skilled nursing care