Durable Medical Equipment Reference List - durable medical equipment suppliers near me

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UnitedHealthcare? Medicare Advantage
Policy Guideline
Durable Medical Equipment Reference List
Guideline Number: MPG083.11
Approval Date: August 10, 2022 Terms and Conditions
Table of Contents Page Related Medicare Advantage Policy Guidelines
Policy Summary ............................................................................. 1 ? See References
Applicable Codes .......................................................................... 2
Definitions ....................................................................................18 Related Medicare Advantage Coverage Summaries
References...................................................................................18 ? Durable Medical Equipment (DME), Prosthetics,
Guideline History/Revision Information .....................................20 Corrective Appliances/Orthotics (Non-Foot
Purpose ........................................................................................22 Orthotics), Nutritional Therapy and Medical Supplies
Terms and Conditions .................................................................22 Grid
? Durable Medical Equipment, Prosthetics, Corrective
Appliances/Orthotics and Medical Supplies
Policy Summary
See Purpose
Overview
The durable medical equipment (DME) list below is designed to facilitate UnitedHealthcare's processing of DME claims. 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 information contained herein is applicable (where
appropriate) to all Centers for Medicare & Medicaid Services (CMS) guidance discussed in the DME portion of this policy
guideline.
Guidelines
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
member, or cross-refers to another CMS source or UnitedHealthcare's policy guideline 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.
When UnitedHealthcare receives a claim for an item of equipment which does not appear to fall logically into any of the generic
categories listed, UnitedHealthcare has the authority and responsibility for deciding whether those items are covered under the
DME benefit.
These decisions must be made by UnitedHealthcare 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 Page 1 of 23
UnitedHealthcare Medicare Advantage Policy Guideline Approved 08/10/2022
Proprietary Information of UnitedHealthcare. Copyright 2022 United HealthCare Services, Inc.
Note: As outlined in the Medicare Benefit Policy Manual Chapter 20, Section 10.2 Coverage Table for DME Claims.
Reimbursement may be made for expenses incurred by a patient for the rental or purchase of durable medical equipment
(DME) for use in his/her home.
*DME must be for use in patient's residence other than a health care institution.
Applicable Codes
The following list(s) of codes is provided for reference purposes only and may not be all inclusive. Listing of a code in this
guideline does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage
for health services is determined by the member specific benefit plan document and applicable laws that may require coverage
for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Other
Policies and Guidelines may apply.
Durable Medical Equipment Reference List
Equipment Name/Type Coverage Status Reference NCD or PG Potential Coding
Air Cleaners Deny - environmental control *NCD 280.1 Durable Medical See reference NCD
equipment; not primarily medical Equipment Reference List or PG
in nature (?1861(n) of the Act).
Air Conditioners Deny - environmental control *NCD 280.1 Durable Medical See reference NCD
equipment; not primarily medical Equipment Reference List or PG
in nature (?1861 (n) of the Act).
Air-Fluidized Beds (See Air-Fluidized Beds, ?280.8 of *NCD 280.8 Air-Fluidized Bed See reference NCD
the NCD Manual.) *Pressure Reducing Support or PG
Surfaces Policy Guideline
Alternating Pressure Pads, Covered if patient has, or is highly *Pressure Reducing Support See reference NCD
Mattresses and Lambs Wool susceptible to, decubitus ulcers Surfaces Policy Guideline or PG
Pads and the patient's physician
specifies that he/she has specified
that he will be supervising the
course of treatment.
Alert or Alarm Device Not primarily medical in nature; References may be located in A9280
does not meet the definition of various CMS sourcing (i.e.,
DME. Transmittals, LCD's, LCA's)
and/or UnitedHealth Group
guidelines
Audible/Visible (See Self-Contained Pacemaker *NCD 20.8.2 Self-Contained See reference NCD
Signal/Pacemaker Monitors Monitors) Pacemaker Monitors or PG
*NCD 20.8.3 Cardiac
Pacemakers: Single Chamber
and Dual Chamber Permanent
Cardiac Pacemakers
Augmentative (See Speech Generating Devices, *NCD 50.1 Speech Generating E2500
Communication Devices ?50.1 of the NCD Manual.) Devices E2502
E2504
E2506
E2508
E2510
E2511
E2512
E2599
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UnitedHealthcare Medicare Advantage Policy Guideline Approved 08/10/2022
Proprietary Information of UnitedHealthcare. Copyright 2022 United HealthCare Services, Inc.
Equipment Name/Type Coverage Status Reference NCD or PG Potential Coding
Bathtub Lifts Deny - convenience item; not *NCD 280.1 Durable Medical E0625
primarily medical in nature Equipment Reference List
(?1861(n) of the Act).
Bathtub Seats Deny - comfort or convenience *NCD 280.1 Durable Medical E0240
item; hygienic equipment; not Equipment Reference List E0245
primarily medical in nature
(?1861(n) of the Act)
Bead Beds (See ?280.8 of the NCD Manual.) *NCD 280.8 Air-Fluidized Bed See reference NCD
*Pressure Reducing Support or PG
Surfaces Policy Guideline
Bed Baths (home type) Deny - hygienic equipment; not *NCD 280.1 Durable Medical See reference NCD
primarily medical in nature Equipment Reference List or PG
(?1861(n) of the Act)
Bed Lifters (bed elevators) Deny - not primarily medical in *NCD 280.1 Durable Medical See reference NCD
nature (?1861(n) of the Act) Equipment Reference List or PG
Bedboards Deny - not primarily medical in *NCD 280.7 Hospital Beds See reference NCD
nature (?1861(n) of the Act) or PG
Bed Pans (autoclavable Covered if patient is bed confined. *NCD 280.1 Durable Medical E0275
hospital type) Equipment Reference List E0276
Bed Side Rails (See Hospital Beds, ?280.7 of the *NCD 280.7 Hospital Beds See reference NCD
NCD Manual.) or PG
Beds-Lounges (power or Deny - not a hospital bed; comfort *NCD 280.1 Durable Medical See reference NCD
manual) or convenience item; not primarily Equipment Reference List or PG
medical in nature (?1861(n) of the
Act).
Beds (Oscillating) Deny - institutional equipment; *NCD 280.1 Durable Medical E0270
inappropriate for home use. Equipment Reference List
Bidet Toilet Seats Deny - not medical equipment *NCD 280.1 Durable Medical See reference NCD
(?1861(n) of the Act) Equipment Reference List or PG
Biofeedback Device Deny - inappropriate for home use. *NCD 30.1 Biofeedback Therapy E0746
(See ?30.1 of the NCD Manual.) *NCD 30.1.1 Biofeedback
Therapy for the Treatment of
Urinary Incontinence
Blood Glucose Analyzers Deny - unsuitable for home use *NCD 40.2 Home Blood Glucose See reference NCD
(Reflectance Colorimeter) (see ?40.2 of the NCD Manual). Monitors or PG
Blood Glucose Monitors Covered if patient meets certain * NCD 40.2 Home Blood See reference NCD
conditions (see ?40.2 of the NCD Glucose Monitors or PG
Manual) *Continuous Glucose Monitors
Policy Guideline
Braille Teaching Texts Deny - educational equipment; not *NCD 280.1 Durable Medical See reference NCD
primarily medical in nature Equipment Reference List or PG
(?1861(n) of the Act).
Durable Medical Equipment Reference List Page 3 of 23
UnitedHealthcare Medicare Advantage Policy Guideline Approved 08/10/2022
Proprietary Information of UnitedHealthcare. Copyright 2022 United HealthCare Services, Inc.


What durable equipment will Medicare pay for?There are many types of Durable Medical Equipment that can help improve your quality of life. Examples of DME covered by Medicare include: Hospital beds Infusion supplies Oxygen equipment and accessories Power scooters Walkers Wheelchairs How-To Find Medical Equipment & Supplies Near You

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