![]() Is appropriate for use in a patient’s home.ĭeny - environmental control equipment not primarily medical in nature (§1861(n) of the Act).ĭeny - environmental control equipment not primarily medical in nature (§1861 (n) of the Act).Generally is not useful to a person in the absence of illness or injury and,.Is primarily and customarily used to serve a medical purpose.Can withstand repeated use i.e., could normally be rented and used by successive patients.The term DME is defined as equipment which: Whether the item is reasonable and necessary for the individual patient.Whether the item has been approved for marketing by the Food and Drug Administration (FDA) and is otherwise generally considered to be safe and effective for the purpose intended and.The Medicare Claims Processing Manual, Chapter 20, "Durable Medical Equipment, Prosthetics and Orthotics, and Supplies (DMEPOS).".These decisions must be made by each MAC based on the advice of its medical consultants, taking into account: When the MAC receives a claim for an item of equipment which does not appear to fall logically into any of the generic categories listed, the MAC has the authority and responsibility for deciding whether those items are covered under the DME benefit. This DME list will be updated periodically to reflect any additional NCDs that CMS may make with regard to other categories of equipment. With respect to equipment categories that cannot be covered as DME, the list includes a brief explanation of why the equipment is not covered. ![]() In the case of equipment categories that have been determined by CMS to be covered under the DME benefit, the list outlines the conditions of coverage that must be met if payment is to be allowed for the rental or purchase of the DME by a particular patient, or cross-refers to another section of the manual where the applicable coverage criteria are described in more detail. ![]() The first column lists alphabetically various generic categories of equipment on which NCDs have been made by the Centers for Medicare & Medicaid Services (CMS) the second column notes the coverage status. The information contained herein is applicable (where appropriate) to all DME national coverage determinations (NCDs) discussed in the DME portion of this manual. This section is designed as a quick reference tool for determining the coverage status of certain pieces of DME and especially for those items commonly referred to by both brand and generic names. The durable medical equipment (DME) list that follows is designed to facilitate the Medicare Administratinve Contractor’s (MAC's) processing of DME claims.
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