Medicare Requirements
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.