Medicare Reqirements

 

Medicare Documentation Requirements for Durable Medical Products

 

Item 

Limitations       

Documentation 

Cane

Every 5 years, no previous walker, MWC, PWC or scooter                    

Prescription with relevant diagnosis, except pain.                                       

Walker

Every 5 years, no previous MWC, PWC or scooter                             

Prescription with relevant diagnosis except pain.

Rollator

Same as walker

Same as walker.  Must pay in full.  Medicare will be billed on patient’s behalf for possible                       reimbursement.                                                      

Manual Wheelchair**

Every 5 years, no previous PWC or scooter.                                             

Prescription/Mobility Evaluation form, Face to Face.                                                                     

Nebulizer**

Every 5 years (rent to own)

Prescription with relevant diagnosis other than wheezing or generic diagnosis plus Office Notes from Doctor.                                                            

Hospital Bed**

Every 5 years

Prescription/Hospital bed CMN/Only diagnoses of heart, lung or aspiration, plus Face to Face.        

Hoyer Lift

Every 5 years

Prescription with relevant Diagnosis.

Diabetic Shoes

Yearly

Prescription from PCP only, diagnosis of diabetes AND diagnosis of a foot condition.                           

Bathroom equipment

Not covered with exception of commode (see documentation requirements)                            

Commode covered when prescription states patient is confined to a single room/floor without a bathroom.                                                                    

Braces (back, knee, wrist supports/AB binder)

Not covered unless rigid

Rigid brace with prescription. Soft braces are not covered.                                                                     

Braces (Wrist)

Every 2 years

Prescription with relevant diagnosis, except pain.

Stairlifts

Not Covered

.

Compression Socks

Insurance Dependent, Usually 2 – 4 pairs per year                                    

Prescription with relevant diagnosis.


**
Face-to-face requirements effective late 2013.