This 146 page report details hundreds of specific review criteria for supply and DME items. Also included is an alpha list with explanatory recommendation for basis to deny or approve for payment based on usual coverage 'medical necessity' determinations.
Table of Contents
Preface, Disclosure, Copyright Information;
Medicare Coverage and Payment Rules;
Disposable medical supplies
Diabetic supplies
Incontinence supplies;
Ostomy supplies;
Surgical dressings
Unna boot;
Urological supplies
Durable Medical Equipment (DME)
Definitions
Ambulatory blood Pressure Monitor;
Ambulatory electrocardiography: Cardiac event monitors, Holter monitors, Implanted loop recorders, Mobile cardiac outpatient telemetry;
Anodyne® (near-infrared) Therapy for Peripheral Neuropathy or Any Condition
Apnea monitor
Pressure Reducing Support Surfaces – Introduction
- Pressure Reducing Support Surfaces – Group 1
- Pressure Reducing Support Surfaces – Group 2 and 3
Air Fluidized Beds - Medicare LMRP
Bathroom and Toilet Equipment and Supplies
Hospital beds; Bed Accessories including trapeze bars
- Bed and Pillow Covers for Asthmatics
- Bed-wetting Alarm
Breast Pumps
Cardiac Defibrillators, home use
Catheters, Urinary
Traction devices; Cervical traction
Traction for low back pain
Chairs, therapeutic
- Gravity lumbar reduction chairs
Communication devices/aides; Speech generating devices
- Tracheo-esophageal voice prostheses, Indwelling
- Augmentive communication aides; Communication board
Compression Garments in the Treatment of Venous Stasis Ulcers
Continuous passive motion device
Cooling devices
Cranial Remodeling Band/Helmet for infants with asymmetrical heads
Diabetes mellitus related DME
- Glucose monitors, blood
- Continuous Glucose Monitoring
- External insulin pumps
- GlucoWatch® Biographer – automatic glucose value without needle-stick
- H-wave stimulation for the treatment of diabetic neuropathy
- Jet Injectors for Insulin Administration
- Insulin Pens
- Shoes, therapeutic
- Sleep sentry to detect hypoglycemia
Electrical Stimulation Modalities
- Dorsal Column Stimulators/Spinal Cord Stimulators: Chronic pain, Angina pectoris
- Neuromuscular electrical stimulation (NMES) for disuse atrophy
- Treatment of Motor Function Disorders with Electric Nerve Stimulation - Medicare NCD
- Neuromuscular or Therapeutic Electrical Stimulation (TES)
- Transcutaneous electrical nerve stimulation (TENS)
- Supplies – Form-fitting Conductive Garment for TENS or NMES
- TENS – Medicare LMRPs
- Inferential current stimulation
- Non-Implantable Pelvic Floor Electrical Stimulator
- ReliefBand
- ‘Sympathetic Therapy’
- Percutaneous electrical nerve stimulation (PENS)
- Implanted Peripheral Electrical Nerve Stimulation – Medicare LMRP
- Electrical Stimulation/Electro-magnetic Therapy for the Treatment of Wounds: Chronic Stage III & IV Musculo-Cutaneous Ulcerations
- Electrogalvanic Stimulators for Levator Syndrome
Environmental Control Systems
Vaporizers
Exercise Equipment
Hearing aids
- Bone-anchored Hearing Aid
Infusion pumps, external; implantable
Intra-oral appliances for the management of headache syndromes, TMJ
Jobst burn garments
Lifts: Seat and Patient
Light Emitting Diode (LED) or Infrared Therapy
Light therapy/phototherapy for seasonal affective disorder
Lymphedema ‘pump’/Manual lymph drainage
Magnetic Pelvic Floor Stimulation (MPFS) or Extracorporeal Magnetic Innervation (ExMI) therapy for Incontinence
Pulmonary DME: Airway Clearance/High Frequency Chest Wall Oscillation Devices; Mechanical in-exsufflation/in-exsufflator devices; Intrapulmonary Percussive Ventilator (IPV); Nebulizers; Oxygen coverage including portable, home oxygen; Peak expiratory flow meters; postural drainage; Respiratory assist devices; Suction pumps; vaporizers
Obstructive Sleep Apnea (OSA) Therapies: CPap for OSA; Noninvasive positive-pressure ventilation (NPPV)/Bilevel Positive Airway Pressure (BiPAP); Sleep Apnea, Noninvasive Positive Pressure Ventilation (NPPV)/Bi-PAP, C-PAP – References/resources; Palatal implants for obstructive sleep apnea (OSA)
Wound Care: Electrical Stimulation/Electro-magnetic Therapy for the Treatment of Wounds: Chronic Stage III & IV Musculo-Cutaneous Ulcerations; Negative pressure wound therapy (NPWT) Pumps; Noncontact Normothermic Wound Therapy/Radiant Heat Wound Therapy Systems; Pneumatic Compression Therapy/Circulator Boot – End-diastolic for extremity ulcers, lymphedema
Orthotic (braces) and Prosthetic Devices; CERT document checklist links
- Aircast ankle brace
- Breast prosthesis, specialized bras for women post-mastectomy
- Canes and crutches
- Corsets
- Dynamic Splinting Devices;
- Facial prostheses
- Foot Orthotics/Prosthetics; Shoe(s), Therapeutic;
- Hand neuroprosthesis
- Knee braces
- Lower limb prostheses, above-knee, computerized
- Magnetic insoles for plantar heel pain
- Magnetic Pelvic Floor Stimulation (MPFS);
- Myoelectric prosthesis, upper extremity;
- Scoliosis Braces
- Spinal Orthoses – TLSO, LSO
- Spinal Unloading Devices
- Splints, Strapping & Casting
Pneumatic Compression Therapy - End-diastolic for non-healing extremity ulcers;
Peak expiratory flow meter;
Prothrombin Time – Home Testing Systems/Coagulometers;
Safety items for patient use
ThairapyÒ vest for cystic fibrosis; Thairapy Bronchial Drainage System;
Therabite® Jaw Motion Rehabilitation System;
Sexual Function Restorative Devices;
- Male: Non-invasive suction or vacuum constriction devices; Penile prosthesis implantation
- Female
Standers, Boards and Tilt Tables;
Vitrectomy Face Support
Mobility Assistive Equipment: Walkers; Wheelchairs, Power-type and Power-operated vehicles (POVs); Wheelchair seats, cushions and back supports
Whirlpool
Wigs
DME Screening List - Review criteria for 290 additional items
Web Site Resources
Reuse Information Resource
Medicare Advance Beneficiary Notice and Limits on Beneficiary Liability for DMS/DME
