Medicare Regulations for Durable Medical Equipment

Medicare Part B code includes coverage for durable medical equipment--certain devices that you use on a regular basis, such as walkers and wheelchairs, reports the Centers for Medicare and Medicaid Services. It is vital that you understand Medicare regulations for durable equipment, because not every durable medical device qualifies for Medicare reimbursement.

Identification

• While Medicare has regulations for each specific type of durable medical equipment, by following a few guidelines you can gauge whether Medicare will cover it. Most importantly, the primary care physician must deem it a medical necessity for your condition. You must be able to use the durable device only for a medical purpose at your residence, and Medicare will pay only for equipment from certified Medicare medical equipment providers, reports the Center for Medicare Advocacy (CMA).

Misconceptions

• Medicare restrictions on durable medical equipment for non-medical use often take precedence over a "medical necessity." Air conditioners are a common example. A person may need their air cooled for certain medical conditions, but by and large it is not considered a medical device, reports the CMA. These restrictions can change. Water beds, for example, are now sometimes considered a medical device.

Features

• Medicare pays 80 percent of the cost of simple items like canes and custom-made durable medical equipment, reports the CMA. For more expensive items, such as wheelchairs and hospital beds, Medicare offers two options: rent or buy. With rental, Medicare pays the monthly costs for 15 months. After that, Medicare will pay for use of the device, and maintenance every six months, but the supplier retains complete equity. With the purchase option, Medicare will pay for 13 months of rent and then 80 percent of its worth and maintenance, but you get to keep the item.

Warning

• A difference exists between suppliers who participate in Medicare and those who are just "enrolled," reports the Center for Medicare and Medicaid Services. Enrolled durable medical equipment suppliers can choose not to accept Medicare's standard payment for the item and charge any amount, but participating suppliers must accept Medicare's "assigned" payment.

Tips

• The kinds of durable medical equipment covered by Medicare policies changes every year, reports the National Caregivers Library. The NCL has a list of approved durable medical devices (and their restrictions) listed on its website for 2009. It is highly recommended that you compare this list to any of your durable medical equipment needs.