MEDICARE NONCOVERED DURABLE MEDICAL EQUIPMENT
 
 Medicare does pay for many kinds of durable medical equipment (DME), Prosthetics, orthotics, and supplies. These items help you move around in your home or help you when you are sick or injured.
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Sometimes your doctor may prescribe or you may want an item that medicare will not pay for. This is called a noncocered service. See theh following list of noncovered services:
 
Insulin by injection                                                                     Special TV for close caption
Insulin syringes                                                                           Air conditioners
Wigs (cranial prosthetics)d                                                       Most prescription drugs
Stair lifts                                                                                      Home modifications                              
Grabbers                                                                                       Bath aids
Ramps                                                                                           Wheelchairs lifts
Adult diapers                                                                                Exercise equipment
Hearing aids                                                                                 Reading machines
Surgical stockings or hose                                                         White cane for the blind
 
 
*May be covered under the Medicare Part D drug benefit
 
Medicare will never pay for these items. IF you want one, or your doctor prescribes one. You or your other insurance will have to pick up the cost. Even with a prescription from your doctor, Medicare cannot pay for non-covered items.
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If you are unsure if an item is covered by Medicare, call 1-800-MEDICARE to find out. No items or services can be approved over the phone.
 
Remember:  An Item that is denied as noncovered is different than an item that is denied as not medically necessary. If your claim for a piece of DME is denied, that may mean that the item does not meet the coverage criteria in a medical policy of that there is not enough information to prove why you need the DME. You can always appeal a medical necessity denial. You cannot appeal a noncovered item.  
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Call 1-800-MEDICARE (1-800-633-4227) or Visit www.NGSMedicare.com -or- www.medicare.gov


 

People with Medicare Checklist for Durable Medical Equipment Coverage
General Information
Medicare covers home medical equipment for Medicare beneficiaries. Items covered but not limited to: blood glucose monitors, diabetic supplies, oxygen, crutches, canes, walkers, etc…Claims for these items fall into different groups such as Durable Medical Equipment (DME), Prosthetics, Orthotics, and Supplies (DMEPOS). These items must be medically necessary. Medically necessary is defined as services or supplies that:

ƒ       Are proper and needed for the diagnosis or treatment of your medical condition
ƒ       Are provided for the diagnosis, direct care, and treatment of you medical condition
ƒ       Meet the standards of good medical practice in the local area
ƒ       Are not mainly for the convenience of you or your doctor

DME Coverage Checklist for People with Medicare

If you think you might need a DME item, take the steps below:

ƒ       Do not purchase a DME item on your own without seeing your first

ƒ       Schedule a doctor’s visit so he or she can assess your need for DME item(s)

ƒ       A DME item must be ordered by your doctor

ƒ       Go to a Medicare approced supplier which agrees to accept assignment on all claims

ƒ       To find a Medicare approved supplier in you community call: 1-800-Medicare or visit www.medicare.gov or www.NGSMedicare.com *(AZ Medical Supplies is an approved Medicare Supplier)

ƒ       Know that all Medicare supplies must file claims with Medicare

ƒ       The DME item must be used for a medical propose or reason

ƒ       DME must withstand repeated use and be long lasting

ƒ       DME item is used in your home

ƒ       Some DME items may require more information that requires your doctor to fill out a form called a Certificate of Medical Necessity (CMN)

DME Items that Require a CMN

ƒ       Air-fluidized beds
ƒ       External fusion pumps
ƒ       Oxygen
ƒ       Seat lift mechanisms
ƒ       Lymphedema pump / pneumatic compression devices
ƒ       Bone growth (or osteogenesis) stimulators
ƒ       Hospital Beds
ƒ       Power Operated vehicles (POV’s) or scooters
ƒ       Wheelchairs (manual and electric)
ƒ       Transcutaneous Electric Nerve Stimulators (TENS)

Note: Different rules for DME coverage apply for stays at nursing or skilled nursing facilities, as well as receiving services from home health and hospice agencies.


* To get even more help with DME Medicare Questions, call:
1-800-Medicare (1-800-633-4227)