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Disposable Medical Supplies/Durable Medical Equipment, 5th edition (update 2013) Product Image

Disposable Medical Supplies/Durable Medical Equipment, 5th edition (update 2013)

  • Published: January 2013
  • Region: Global
  • 131 Pages
  • Apollo Managed Care, Inc.

Durable medical equipment (DME) may not be a covered benefit unless the individual or their employer has purchased a DME rider. However, certain DME is integral to the treatment (surgical and non-surgical) of many conditions (e.g., orthopedic casts, supportive and functional braces, splints) and are covered even though a DME benefit is not delineated in the Certificate of Coverage or an associated rider.

Definition of Durable Medical Equipment

For purposes of coverage durable medical equipment is equipment which:

1) Can withstand repeated use, and
2) is primarily and customarily used to service a medical purpose, and
3) generally is not useful to a person in the absence of illness or injury and
4) is appropriate for use in the home.

This report covers hundreds of specific review criteria for supply and DME Items, plus an alpha list with explanatory recommendation for the basis to deny or approve payment, based on the usual coverage of 'medical necessity' determinations. The report includes references and web links.

Preface, Disclosure, Copyright Information;

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;
- ART device
- Bathroom and Toilet Equipment and Supplies;
- Commodes;
- Beds/Pressure Reducing Support Surfaces – Introduction;
- Pressure Reducing Support Surfaces – Group 1;
- Pressure Reducing Support Surfaces – Group 2 and 3;
- Air Fluidized Beds ;
- Hospital beds;
- Bed accessories: 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;
-- H-wave stimulation for the treatment of diabetic neuropathy
-- Jet Injectors for Insulin Administration;
-- Insulin Pens; Insulin syringes;
-- Shoes, therapeutic;
-- Sleep sentry to detect hypoglycemia;

- Diathermy;

- 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
- Mobility Assistive Equipment: Strollers; Walkers/Rollers; Wheelchairs, Power-type and Power-operated vehicles (POVs); INDEPENDENCE iBOT 4000 Mobility System; Wheelchair seats, cushions and back supports
- 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
Hernia Truss/Sykes;
Knee braces
Lower limb prostheses, above-knee, computerized
Magnetic insoles for plantar heel pain
Magnetic Pelvic Floor Stimulation (MPFS);
Myoelectric prosthesis, upper extremity;
Lower limb computerized prosthesis
Prosthesis criteria: functional levels
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;
- Ultraviolet B Home Therapy;
- Vitrectomy Face Support;
- Whirlpool;
- Wigs;
- DMS/DME Miscellaneous List - Review criteria for 275 additional items;

Addenda

- Web Resources
- Reuse Information Resource
- Medicare Advance Beneficiary Notice and Limits on Beneficiary Liability for DMS/DME;
- Accreditation organizations for suppliers of durable medical equipment, prosthetics, orthotics and supplies

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