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National Coverage Determination (NCD)

Durable Medical Equipment (DME) Reference List

280.1

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Tracking Information

Publication Number
100-3
Manual Section Number
280.1
Manual Section Title
Durable Medical Equipment (DME) Reference List
Version Number
1
Effective Date of this Version
04/01/2003
Ending Effective Date of this Version
05/05/2005
Implementation Date
04/01/2003
Implementation QR Modifier Date

Description Information

Benefit Category
Durable Medical Equipment


Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Item/Service Description

The term DME is defined as equipment which:

  • Can withstand repeated use; i.e., could normally be rented, and used by successive patients;

  • Is primarily and customarily used to serve a medical purpose;

  • Generally is not useful to a person in the absence of illness or injury; and

  • Is appropriate for use in a patient's home.
Indications and Limitations of Coverage

The DME list which follows is designed to facilitate your processing of DME claims. This section is designed to be used as a quick reference tool for determining the coverage status of certain pieces of DME and especially for those items which are commonly referred to by both brand and generic names. The information contained herein is applicable (where appropriate) to all DME coverage determinations discussed in the DME portion of this manual. The list is organized into two columns. The first column lists alphabetically various generic categories of equipment on which national coverage decisions have been made by CMS; and the second column notes the coverage status of each equipment category.

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. With respect to equipment categories that cannot be covered as DME, the list includes a brief explanation of why the equipment is not covered. This DME list will be updated periodically to reflect any additional national coverage decisions that CMS may make with regard to other categories of equipment.

When you receive a claim for an item of equipment which does not appear to fall logically into any of the generic categories listed, you have the authority and responsibility for deciding whether those items are covered under the DME benefit. These decisions must be made by each contractor based on the advice of its medical consultants, taking into account:

The Medicare Claims Processing Manual, Chapter 20, "Durable Medical Equipment, Prosthetics and Orthotics, and Supplies (DMEPOS)."

  • 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
  • Whether the item is reasonable and necessary for the individual patient.

Durable Medical Equipment Reference List

Item Coverage
Air Cleaners Deny environmental control equipment; not primarily medical in nature (§1861(n) of the Act).
Air Conditioners Deny environmental control equipment; not primarily medical in nature (§1861 (n) of the Act).
Air-Fluidized Bed (See Air-Fluidized Bed, §280.8 of the NCD Manual.)
Alternating Pressure Pads, Mattresses and Lambs Wool Pads Covered if patient has, or is highly susceptible to, decubitus ulcers and the patient’s physician has specified that he will be supervising his course of treatment.
Audible/Visible Signal/Pacemaker Monitor (See Self-Contained Pacemaker Monitor.)
Augmentative Communication Device (See Speech Generating Devices, §50.1 of the NCD Manual.)
Bathtub Lifts Deny convenience item; not primarily medical in nature (§1861(n) of the Act).
Bathtub Seats Deny comfort or convenience item; hygienic equipment; not primarily medical in nature (§1861(n) of the Act).
Bead Bed (See §280.8 of the NCD Manual.)
Bed Baths (home type) Deny hygienic equipment; not primarily medical in nature (§1861(n) of the Act).
Bed Lifter (bed elevator) Deny not primarily medical in nature (§1861(n) of the Act).
Bedboards Deny not primarily medical in nature (§1861(n) of the Act).
Bed Pans (autoclavable hospital type) Covered if patient is bed confined.
Bed Side Rails (See Hospital Beds, §280.7 of the NCD Manual.)
Beds-Lounge (power or manual) Deny not a hospital bed; comfort or convenience item; not primarily medical in nature (§1861(n) of the Act).
Beds Oscillating Deny institutional equipment; inappropriate for home use.
Bidet Toilet Seat (See Toilet Seats.)
Blood Glucose Analyzer Reflectance Colorimeter Deny unsuitable for home use (see §40.2 of the NCD Manual).
Blood Glucose Monitor Covered if patient meets certain conditions (see §40.2 of the NCD Manual).
Braille Teaching Texts Deny educational equipment; not primarily medical in nature (§1861(n) of the Act).
Canes Covered if patient’s condition impairs ambulation (see §280.2 of the NCD Manual).
Carafes Deny convenience item; not primarily medical in nature (§1861(n) of the Act).
Catheters Deny nonreusable disposable supply (§1861(n) of the Act). (See The Medicare Claims Processing Manual, Chapter 20, Durable Medical Equipment, Prosthetics and Orthotics, and Supplies (DMEPOS).)
Commodes Covered if patient is confined to bed or room.

NOTE: The term “room confined” means that the patient’s condition is such that leaving the room is medically contraindicated.   The accessibility of bathroom facilities generally would not be a factor in this determination. However, confinement of a patient to his home in a case where there are no toilet facilities in the home may be equated to room confinement. Moreover, payment may also be made if a patient’s medical condition confines him to a floor of his home and there is no bathroom located on that floor.
Communicator (See §50.1 of the NCD Manual, “Speech Generating Devices.”)
Continuous Passive Motion Continuous passive motion devices are devices Covered for patients who have received a total knee replacement. To qualify for coverage, use of the device must commence within 2 days following surgery. In addition, coverage is limited to that portion of the three week period following surgery during which the device is used in the patient’s home. There is insufficient evidence to justify coverage of these devices for longer periods of time or for other applications.
Continuous Positive Airway Pressure (CPAP) (See §240.4 of the NCD Manual.)
Crutches Covered if patient’s condition impairs Ambulation.
Cushion Lift Power Seat (See Seat Lifts.)
Dehumidifiers (room or central    heating system type) Deny environmental control equipment; not primarily medical in nature (§1861(n) of the Act).
Diathermy Machines (standard pulses wave types) Deny inappropriate for home use (see §150.5 of the NCD Manual).
Digital Electronic Pacemaker Monitor (See Self-Contained Pacemaker Monitor.)
Disposable Sheets and Bags Deny nonreusable disposable supplies (§1861(n) of the Act).
Elastic Stockings Deny nonreusable supply; not rental-type items (§1861(n) of the Act). (See §270.5 of the NCD Manual.)
Electric Air Cleaners Deny (See Air Cleaners.) (§1861(n) of the Act).
Electric Hospital Beds (See Hospital Beds §280.7 of the NCD Manual.)
Electrical Stimulation for Wounds Deny inappropriate for home use. (See §270.1 of the NCD Manual.)
Electrostatic Machines Deny (See Air Cleaners and Air Conditioners.) (§1861(n) of the Act).
Elevators Deny convenience item; not primarily medical in nature (§1861(n) of the Act).
Emesis Basins Deny convenience item; not primarily medical in nature (§1861(n) of the Act).
Esophageal Dilator Deny physician instrument; inappropriate for patient use.
Exercise Equipment Deny not primarily medical in nature (§1861(n) of the Act).
Fabric Supports Deny nonreusable supplies; not rental-type it (§1861(n) of the Act).
Face Masks (oxygen) Covered if oxygen is covered. (See §240.2 of the NCD Manual.)
Face Masks (surgical) Deny nonreusable disposable items (§1861(n) of the Act).
Flowmeter (See Medical Oxygen Regulators.) (See §240.2 of the NCD Manual.)
Fluidic Breathing Assister (See Intermittent Positive Pressure Breathing Machines.)
Fomentation Device (See Heating Pads.)
Gel Flotation Pads and Mattresses   (See Alternating Pressure Pads and Mattresses.)
Grab Bars Deny self-help device; not primarily medical in nature (§1861(n) of the Act).
Heat and Massage Foam Cushion Pad Deny not primarily medical in nature; personal comfort item (§§1861(n) and 1862(a)(6) of the Act).
Heating and Cooling Plants Deny environmental control equipment not primary; medical in nature (§1861(n) of the Act).
Heating Pads Covered if the contractor’s medical staff determines patient’s medical condition is one for which the application of heat in the form of a heating pad is therapeutically effective.
Heat Lamps Covered if the contractor’s medical staff determines patient’s medical condition is one for which the application of heat in the form of a heat lamp is therapeutically effective.
Hospital Beds (See §280.7 of the NCD Manual.)
Hot Packs (See Heating Pads.)
Humidifiers (oxygen) (See Oxygen Humidifiers.)
Humidifiers (room or central heating system types) Deny environmental control equipment; not medical in nature (§1861(n) of the Act).
Hydraulic Lift (See Patient Lifts.)
Incontinent Pads Deny nonreusable supply; hygienic item (§1861(n) of the Act).
Infusion Pumps For external and implantable pumps, see §40.2 of the NCD Manual.   If the pump is used with an enteral or parenteral nutritional therapy system.  (See §180.2 of the NCD Manual for special coverage rules.)
Injectors (hypodermic jet Deny not covered self-administered drug supply;pressure powered devices (§1861(s)(2)(A) of the Act) for injection of insulin.
Intermittent Positive Pressure Breathing Machines Covered if patient’s ability to breathe is severely impaired.
Iron Lungs (See Ventilators.)
Irrigating Kit Deny nonreusable supply; hygienic equipment (§1861(n) of the Act).
Lambs Wool Pads (See Alternating Pressure Pads, Mattresses, and Lamb Wool Pads.)
Leotards Deny (See Pressure   Leotards.) (§1861(n) of the Act).
Lymphedema Pumps Covered (See Pneumatic Compression Devices, §280.6 of the NCD Manual.)
Massage Devices Deny personal comfort items; not primarily medical in nature (§§1861(n) and 1862(a)(6) of the Act).
Mattress Covered only where hospital bed is medically necessary. (Separate Charge for replacement mattress should not be allowed where hospital bed with mattress is rented.) (See §280.7 of the NCD Manual.)
Medical Oxygen Regulators Covered if patient’s ability to breathe is severely impaired. (See §240.2 of the NCD Manual.)
Mobile Geriatric Chair (See Rolling Chairs.)
Motorized Wheelchairs (See Wheelchairs (power operated).)
Muscle Stimulators Covered for certain conditions. (See §250.4 of the NCD Manual.)
Nebulizers Covered if patient’s ability to breathe is severely impaired.
Oscillating Beds Deny institutional equipment - inappropriate for home use.
Overbed Tables Deny convenience item; not primarily medical in nature (§1861(n) of the Act).
Oxygen Covered if the oxygen has been prescribed for use in connection with medically necessary durable medical equipment. (See §240.2 of the NCD Manual.)
Oxygen Humidifiers Covered if the oxygen has been prescribed for use in connection with medically necessary durable medical equipment for purposes of moisturizing oxygen. (See §240.2 of the NCD Manual.)
Oxygen Regulators (Medical) (See Medical Oxygen Regulators.)
Oxygen Tents (See §240.2 of the NCD Manual.)
Paraffin Bath Units (Portable) (See Portable Paraffin Bath Units.)
Paraffin Bath Units (Standard) Deny institutional equipment; in appropriate or home use.
Parallel Bars Deny support exercise equipment; primarily for institutional use; in the home setting other devices (e.g., a walker) satisfy the patient’s need.
Patient Lifts Covered if contractor’s medical staff determines patient’s condition is such that periodic movement is necessary to effect improvement or to arrest or retard deterioration in his condition.
Percussors Covered for mobilizing respiratory tract secretions in patients with chronic obstructive lung disease, chronic bronchitis, or emphysema, when patient or operator of powered percussor has received appropriate training by a physician or therapist, and no one competent to administer manual therapy is available.
Portable Oxygen Systems 1. Regulated (adjustable Covered under conditions specified in a flow rate). Refer all claims to medical staff for this determination.

2. Preset (flow rate Deny emergency, first-aid, or not adjustable) precautionary equipment; essentially not therapeutic in nature.
Portable Paraffin Bath Units Covered when the patient has undergone a successful trial period of paraffin therapy ordered by a physician and the patient’s condition is expected to be relieved by long term use of this modality.
Portable Room Heaters Deny environmental control equipment; not primarily medical in nature (§1861(n) of the Act).
Portable Whirlpool Pumps Deny not primarily medical in nature; personal comfort items (§§1861(n) and 1862(a)(6) of the Act).
Postural Drainage Boards Covered if patient has a chronic pulmonary condition.
Preset Portable Oxygen Units Deny emergency, first-aid, or precautionary equipment; essentially not therapeutic in nature.
Pressure Leotards Deny non-reusable supply, not rental-type item (§1861(n) of the Act).
Pulse Tachometer Deny not reasonable or necessary for monitoring pulse of homebound patient with or without a cardiac pacemaker.
Quad-Canes (See Walkers.)
Raised Toilet Seats Deny convenience item; hygienic equipment; not primarily medical in nature (§1861(n) of the Act).
Reflectance Colorimeters (See Blood Glucose Analyzers.)
Respirators (See Ventilators.)
Rolling Chairs Covered if the contractor’s medical staff determines that the patient’s condition is such that there is a medical need for this item and it has been prescribed by the patient’s physician in lieu of a wheelchair.   Coverage is limited to those roll-about chairs having casters of at least 5 inches in diameter and specifically designed to meet the needs of ill, injured, or otherwise impaired individuals.

Coverage is denied for the wide range of chairs with smaller casters as are found in general use in homes, offices, and institutions for many purposes not related to the care or treatment of ill or injured persons.   This type is not primarily medical in nature. (See §1861(n) of the Act).
Safety Roller (See §280.5 of the NCD Manual.)
Sauna Baths Deny not primarily medical in nature; personal comfort items (§§1861(n) and 1862(a)(6) of the Act).
Seat Lift Covered under the conditions specified in §280.4 of the NCD Manual. Refer all to medical staff for this determination.
Self Contained Pacemaker Monitor Covered when prescribed by a physician for a patient with a cardiac pacemaker. (See §§20.8.1 and 280.2 of the NCD Manual.)
Sitz Bath Covered if the contractor’s medical staff determines patient has an infection or injury of the perineal area and the item has been prescribed by the patient’s physician as a part of his planned regimen of treatment in the patient’s home.
Spare Tanks of Oxygen Deny convenience or precautionary supply.
Speech Teaching Machine Deny education equipment; not primarily medical in nature (§1861(n) of the Act).
Stairway Elevators Deny (See Elevators.) (§1861(n) of the Act).
Standing Table Deny convenience item; not primarily medical in nature (§1861(n) of the Act).
Steam Packs These packs are Covered under the same condition as a heating pad. (See Heating Pads.)
Suction Machine Covered if the contractor’s medical staff determines that the machine specified in the claim is medically required and appropriate for home use without technical or professional supervision.
Support Hose Deny (See Fabric Supports.) (§1861(n) of the Act).
Surgical Leggings Deny non-reusable supply; not rental-type item (§1861(n) of the Act).
Telephone Alert Systems Deny these are emergency communications systems and do not serve a diagnostic or therapeutic purpose.
Toilet Seats Deny not medical equipment (§1861(n) of the Act).
Traction Equipment Covered if patient has orthopedic impairment requiring traction equipment which prevents ambulation during the period of use (Consider covering devices usable during ambulation; e.g., cervical traction collar, under the brace provision).
Trapeze Bars Covered if patient is bed confined and the patient needs a trapeze bar to sit up because of respiratory condition, to change body position for other medical reasons, or to get in and out of bed.
Treadmill Exerciser Deny exercise equipment; not primarily medical in nature (§1861(n) of the Act).
Ultraviolet Cabinet Covered for selected patients with generalized intractable psoriasis.   Using appropriate consultation, the contractor should determine whether medical and other factors justify treatment at home rather than at alternative sites, e.g., outpatient department of a hospital.
Urinals autoclavable Covered if patient is bed confined hospital type.
Vaporizers Covered if patient has a respiratory illness.
Ventilators Covered for treatment of neuromuscular diseases, thoracic restrictive diseases, and chronic respiratory failure consequent to chronic obstructive pulmonary disease.   Includes both positive and negative pressure types. (See §240.5 of the NCD Manual.)
Walkers Covered if patient’s condition impairs ambulation (See §280.5 of the NCD Manual.)
Water and Pressure Pads and Mattresses (See Alternating Pressure Pads, Mattresses and Lamb Wool Pads.)
Wheelchairs (power operated) Covered if patient’s condition is such and wheelchairs with other that a wheelchair is medically necessary special features and the patient is unable to operate the wheelchair manually.   Any claim involving a power wheelchair or a wheelchair with other special features should be referred for medical consultation since payment for the special features is limited to those which are medically required because of the patient’s condition.   (See §280.9 of the NCD Manual for power operated and §280.3 for specially sized wheelchairs.)

NOTE: A power-operated vehicle that may appropriately be used as a wheelchair can be Covered.   (See §280.9 of the NCD Manual for coverage details.)
Whirlpool Bath Equipment Covered if patient is homebound and has a (standard)condition for which the whirlpool bath can be expected to provide substantial therapeutic benefit justifying its cost.   Where patient is not homebound but has such a condition, payment is restricted to the cost of providing the services elsewhere; e.g., an outpatient department of a participating hospital, if that alternative is less costly. In all cases, refer claim to medical staff for a determination.
Whirlpool Pumps Deny (See Portable Whirlpool Pumps.) (§1861(n) of the Act).
White Cane Deny (See §280.2 of the NCD Manual.)
Cross Reference
The Medicare Benefit Policy Manual, Chapter 15, “Covered Medical and Other Health Services.”
The Medicare Claims Processing Manual, Chapter 20, “Durable Medical Equipment, Prosthetics and Orthotics, and Supplies (DMEPOS).”
Claims Processing Instructions

Transmittal Information

Transmittal Number
161
Coverage Transmittal Link
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R161CIM.pdf
Revision History

11/2002 - Provided that unsupervised home use of electrical stimulation for treatment of wounds not covered. Effective and implementation dates 04/01/2003. (TN 161) (CR 2313)

11/2000 - Changed benefit category and coverage status of augmentive and alternative communication devices. Devices now fall within the DME benefit category and will be covered if contractor's medical staff determines that patient's medical condition warrants the device based on information found at 60-23. Effective and implementation dates 01/01/2001. (TN 132) (CR 1328)

02/1999 - Clarified non-coverage policy for hypodermic jet pressure powered devices for the injection of insulin because of statute rather than effectiveness of device. Effective date NA.(TN 107)

07/1990 - Added air-fluidized bed to DME list. Effective date (TN 44)

05/1989 - Added introduction to facilitate DME claims processing. Deleted references to manufacturers' brand and replaced with generic counterpart. Added statutory authorities for denial if authority other than 1862(a)(1). Added Blood Glucose Analyzer-Reflectance Colorimeter-deny as unsuitable for home use to list. Modified Communicator to specify that in addition to being a convenience item is not primarily medical in nature. Modified Heat and Massage Foam Cushion Pad-deny to specify as not primarily medical in nature; personal comfort item. Modified Injectors to specify that effectiveness not adequately demonstrated. Reorganized Iron Lung, Respirators and Ventilators to more accurately reflect current medical terminology but not affecting the coverage status.  Effective date NA. (TN 36)

12/1986 - Added continuous positive airway pressure to list. Effective date 01/12/1987. (TN 12)

09/1986 - Added segmental therapy type lymphedema pump as covered. Effective date 09/19/1986. (TN 9)
Other

National Coverage Analyses (NCAs)

Coding Analyses for Labs (CALs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with CALs, from the Coding Analyses for Labs database.

Additional Information

Other Versions
Title Version Effective Between
Durable Medical Equipment Reference List 3 05/16/2023 - N/A View
Durable Medical Equipment Reference List 2 05/05/2005 - 05/16/2023 View
Durable Medical Equipment (DME) Reference List 1 04/01/2003 - 05/05/2005 You are here
CPT Copyright Statement
CPT only copyright 2002-2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
Reasons for Denial
Note: This section has not been negotiated by the Negotiated RuleMaking Committee. It includes CMS’s interpretation of it’s longstanding policies and is included for informational purposes. Tests for screening purposes that are performed in the absense of signs, symptoms, complaints, or personal history of disease or injury are not covered except as explicity authorized by statue. These include exams required by insurance companies, business establishments, government agencies, or other third parties. Tests that are not reasonable and necessary for the diagnosis or treatment of an illness or injury are not covered according to the statue. Failure to provide documentation of the medical necessity of tests may result in denial of claims. The documentation may include notes documenting relevant signs, symptoms, or abnormal findings that substantiate the medical necessity for ordering the tests. In addition, failure to provide independent verification that the test was ordered by the treating physician (or qualified nonphysician practitioner) through documentation in the physician’s office may result in denial. A claim for a test for which there is a national coverage or local medical review policy will be denied as not reasonable and necessary if it is submitted without an ICD-9-CM code or narrative diagnosis listed as covered in the policy unless other medical documentation justifying the necessity is submitted with the claim. If a national or local policy identifies a frequency expectation, a claim for a test that exceeds that expectation may be denied as not reasonable and necessary, unless it is submitted with documentation justifying increased frequency. Tests that are not ordered by a treating physician or other qualified treating nonphysician practitioner acting within the scope of their license and in compliance with Medicare requirements will be denied as not reasonable and necessary. Failure of the laboratory performing the test to have the appropriate Clinical Laboratory Improvement Act of 1988 (CLIA) certificate for the testing performed will result in denial of claims.
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