DME (Durable Medical Equipment)

Extended Definition

Durable Medical Equipment (DME) refers to reusable medical devices prescribed by a doctor for use at home. Medicare Part B covers DME when medically necessary.

DME Criteria (Medicare)

To qualify as DME, equipment must:

1. Withstand repeated use - Not disposable
2. Serve a medical purpose - Not for convenience
3. Be appropriate for home use - Not just hospital/clinic
4. Be useful only for illness/injury - Not general wellness

Common DME for Joint Pain

Equipment	Purpose	Coverage
Knee braces	Support/unload joint	Usually covered
Walkers	Mobility assistance	Usually covered
Canes	Balance/support	Usually covered
TENS units	Pain relief	Covered with criteria
CPM machines	Post-surgery motion	Covered post-op
Wheelchairs	Mobility	Covered if needed

Medicare DME Coverage

What’s covered:

• 80% of approved amount after deductible
• Must be ordered by treating physician
• Must use Medicare-approved supplier
• Prior authorization may be required

What’s NOT covered:

• Items for general fitness
• Duplicate equipment
• Items from non-approved suppliers
• Some comfort/convenience items

Tips for Getting DME

1. Get prescription from your doctor
2. Use a Medicare-approved supplier
3. Ask about prior authorization
4. Keep documentation of medical necessity
5. Compare costs between suppliers

Supplier Requirements

Medicare requires using enrolled DME suppliers. Using non-enrolled suppliers means:

• Medicare won’t pay
• You pay full cost
• No appeals process available