Durable Medical Equipment

What Is Durable Medical Equipment?
Written by Nancy McMahon   
Durable medical equipment is defined as reusable medical equipment like wheelchairs, walkers, crutches, hospital beds and more.

It also includes home oxygen equipment and power chairs. If you need durable medical equipment, it is very important to understand the rules and regulations your insurance carrier or Medicare uses to govern the acquisition and use of this equipment. Many insurance and Medicare providers require that you have specific approvals for this equipment and that you get the durable medical equipment from approved providers.

Rules and Regulations Governing Durable Medical Equipment

The rules and regulations governing durable medical equipment vary from policy to policy. Medicare has very specific guidelines and these guidelines can change over time an according to the type of Medicare insurance that you have. Make sure you check your policy and with your doctor before buying or renting the equipment to ensure the best coverage of the costs.

The first requirement will be if the equipment is deemed a medical necessity. Usually a doctor or treating practitioner, like a nurse practitioner, physician assistant, or clinical nurse specialist, will prescribe the specific durable medical equipment to be used in your home.

If you have Medicare, usually a hospital or nursing home will not qualify as a “home,” but a long-term care facility may qualify as your home. So make sure you understand the differences. Sometimes you are responsible for providing the equipment, and sometimes the facility is responsible. Verify with the provider before accepting or procuring the durable medical equipment.

Rent, Buy or Lease

Not all durable medical equipment is treated the same. Some durable medical equipment can only be rented. Some has to be purchased. Some, like oxygen, must be contracted for a specific term and you can’t change providers. Medicare and Medicare Advantage Plans cover the costs differently. The most important thing you can do before you purchase or rent any medical equipment is to find out how your specific coverage will handle the costs.

Often the equipment must be purchased or rented from very specific providers. So if you need equipment, get a list of approved providers from your insurance or Medicare provider.

Requirement For Medical Practitioners

The durable medical equipment, like power chairs, wheel chairs and oxygen, must be prescribed to be used in your home. You generally aren’t “required” to have the equipment if it is only to be used when you leave your home. This is particularly important when you are looking at power chairs. Verify all of the caveats to getting any durable medical equipment.

Besides the prescription, sometimes the doctor or medical practitioner is required to fill out specific forms in order for you to qualify for the durable medical equipment. Medicare calls this a Certificate of Medical Necessity. If the prescription or your medical condition changes, your doctor has to submit an updated certificate.  

Durable medical equipment is used in the home to increase the quality of life. This type of benefit is included in most insurance policies. Power wheelchairs and scooters are considered durable medical equipment by Medicare, but they must be needed in the home and not just for outside use.

Summary

Types of items that are considered to be durable medical equipment include air fluidized beds, canes, commode chairs and crutches. It also includes infusion pumps and some of the medicines used in them. Patient lifts, suction pumps and traction equipment is also considered to be durable medical equipment.

Nebulizers, ventilators, lymphedema pumps are considered to be durable medical equipment, as are transcutaneous electronic nerve stimulators. Basically medical equipment that you would use in your home because of medical necessity, or to increase your quality of life, might be considered to be durable medical equipment.

This extends to, blood-testing strips and other items needed by diabetics. If you have been approved for a seat-lift mechanism, this is usually for the equipment only, and doesn’t include the actual chair.

There are so many conditions and qualifiers with durable medical equipment that it is really necessary to understand your specific policy or Medicare requirements. Make sure you check and get all approvals and conditions in writing before you purchase or buy durable medical equipment. If you changed carriers, verify what the new policies cover. This is especially important with any Medicare Advantage programs.

Again, durable medical equipment is defined as a type of equipment that can be reused. The equipment can be bought, rented or leased for a specific period of time depending on your insurance or Medicare coverage.
 
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