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.