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Repair of Durable Medical Equipment (DME) and External Prosthetic Devices | |
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Description: |
Durable Medical Equipment consists of items which:
Examples of DME include but are not limited to oxygen, wheelchairs , crutches, walkers, hospital beds, traction equipment, ventilators, oxygen, monitors, lifts, and nebulizers.
External prosthetic devices are used to substitute for all or part of non-functioning, absent or malfunctioning body parts. Examples of external prosthetic devices include artificial limbs, removable artificial eyes, external breast prostheses, external pacemakers and defibrillators and electronic speech aids for post-laryngectomy patients.
DME and prosthetic devices may occasionally need repair to restore functioning after damage or from normal wear and tear of the device.
Equipment used for environmental control or to enhance the environmental setting or surroundings of an individual should not be considered durable medical equipment. Examples of these include air conditioners, air filters, humidifiers, etc.
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Policy/ Coverage: |
Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria
Repair of durable medical equipment and external prosthetic devices meets primary coverage criteria when all of the following are met:
Up to one month’s rental for a replacement device to be used while a patient-owned DME is being repaired meets primary coverage criteria. Payment will not exceed the rental allowance for the equipment that is being repaired.
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Rationale: |
Routine maintenance such as testing, cleaning and regulating the equipment is generally the responsibility of the owner of the equipment and it is not expected that another individual would be hired to perform these services.
Monthly DME rental fees customarily cover the cost of maintenance and repair of the rented equipment. Therefore, the coverage applies only for equipment that has been purchased.
2019 Update
Annual policy review completed with a literature search using the MEDLINE database through July 2019. No new literature was identified that would prompt a change in the coverage statement.
2020 Update
Annual policy review completed with a literature search using the MEDLINE database through July 2020. No new literature was identified that would prompt a change in the coverage statement.
2021 Update
Annual policy review completed with a literature search using the MEDLINE database through July 2021. No new literature was identified that would prompt a change in the coverage statement.
2022 Update
Annual policy review completed with a literature search using the MEDLINE database through July 2022. No new literature was identified that would prompt a change in the coverage statement.
2023 Update
Annual policy review completed with a literature search using the MEDLINE database through July 2023. No new literature was identified that would prompt a change in the coverage statement.
2024 Update
Annual policy review completed with a literature search using the MEDLINE database through July 2024. No new literature was identified that would prompt a change in the coverage statement.
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CPT/HCPCS: | |
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Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
CPT Codes Copyright © 2024 American Medical Association. |