What is DME?
Durable medical equipment is any long-term, reusable device that provides therapeutic benefits to patients due to a medical condition, illness, or disability. In order for a device to qualify as a DME, they must primarily serve a medical purpose, be prescribed or ordered by a medical provider, can be used over and over again, be appropriate for home use, and will not be useful to patients without an injury, disability, or illness.
How Do I Pay for DME?
There are 5 primary methods of payment:
- Medicare Coverage: Covers around 80% of the cost
- Medicaid Coverage: Covers most or all expenses
- Veteran’s Benefits: Covers most or all expenses for veterans
- Private Insurance: Covers most of the cost
- Self-Pay: Out of the pocket of the patient
How do I request DME through Medicaid or Medicare?
- Potential candidates for DME should go to a physician to clarify their needs to their physician and inform the physician what coverage option he or she has before the prescription is written.
- The patient needs to find a supplier of the DME that is approved by their coverage provider (Medicaid or Medicare). Both providers have specific vendors that they approve to cover DME.
- If the patient cannot be covered by their provider, good places to get DME are online, medically supply stores, and even local grocery stores.
For more information on what durable medical equipment you can get through medicare and medicaid, visit www.medicare.gov or www.cms.gov.
DME Requirements for Medicare
To qualify:
- Have Medicare Part A or B
- Doctor must prescribe equipment as medically necessary
Forms needed:
- Chart notes, therapy notes, test results
- If denied by Medicare, an Advanced Beneficiary Notice of Noncoverage
DME Requirements for Medicaid
To qualify:
- Seniors 65 years or older of any income, disabled adults
- Doctor must prescribe equipment as medically necessary
Forms needed:
- Chart notes, therapy notes, test results
- Prior Authorization
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