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Health Care Coverage
Durable Medical Equipment (DME)
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Patient Handouts from the CRC
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Definition
Durable medical equipment (DME) is equipment that provides therapeutic benefits to a patient in need because of certain medical conditions or illnesses and can stand repeated use. It may include a variety of items such as walkers, wheelchairs, power scooters, hospital beds and oxygen tanks (not a complete list).
Insurance Coverage
DME suppliers can help to determine if insurance will cover DME. More information below.
MassHealth
- MassHealth DME regulations- Covered DME services- see section 409.413: Covered Services (page 4-9) and Non-Covered DME services - see section 409.414: Noncovered Services (page 4-10).
- Bath and toilet equipment and supplies (commodes, grab bars, tub benches, etc.) and Patient Lifts are covered
- Home or vehicle modifications, such as ramps, elevators, or stair lifts are not covered.
January 2009. See p. 2)
- Special Topics
- MassHealth DME and Oxygen Payment and Coverage Guidelines Tools
- DME vendors/providers must submit the prior authorization to MassHealth. They will work with the physician to get necessary paperwork such as a letter of medical necessity a prescription, and other supporting documentation.
For inquiries related to a procedure or treatment that requires prior authorization (PA), providers should call 1-800-862-8341 (for all services except pharmacy, dental, non-emergency transportation).
- MassHealth introduced PA functionality to the LTSS Provider Portal for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) and Oxygen and Respiratory Therapy Equipment. Since February 1, 2019, all DMEPOS providers cannot submit their MassHealth PAs through the Provider Online Service Center (POSC) and must use the LTSS Provider Portal. The LTSS Provider Portal: https://www.masshealthltss.com. If you need assistance, please contact the LTSS Provider Service Center at 1-844-368-5184 or support@masshealthltss.com. Also see the 2018 DME Provider Portal Training Guide for assistance.
- MassHealth DME Power Wheelchair Benefit - MassHealth has a Durable Medical Equipment (DME) benefit for members with complex power wheelchairs. MassHealth will cover minor repairs to serviceable retired power wheelchairs so that members have a usable backup power wheelchair to use if their current power wheelchair is being fixed.
- The DME mobility provider must first assess the member’s mobility and positioning needs to determine if a suitable power wheelchair is available as a loaner on an as-needed basis.
- If the member’s needs cannot be met using a loaner power wheelchair and the member’s retired chair is serviceable with minor repairs, then the mobility provider should submit a Prior Authorization (PA) for repairs of the serviceable backup wheelchair.
- Call the My Ombudsman Program for more information at (855) 781-9898, videophone (VP) at (339) 224-6831, Monday-Friday, 9 a.m. to 4 p.m.
- From Keep speaking up about the budget, Disability Policy Consortium Weekly Update, April 19, 2024.
- Medicare
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Medicare usually covers DME if the equipment is:
- Durable, meaning you can use it again (excludes items like incontinence pads, catheters, etc.)
- Designed to help a medical condition or injury;
- Suitable to use in the home, although you can also use it outside the home; and
- Likely to last for three years or more.
- Medicare will only cover the cost of your DME if your doctor prescribes it and certifies that you need it to get around your home, not just to get around outside of your home.
- Some examples of DME covered by Medicare are walkers, crutches, wheelchairs, power scooters, seat lifts, hospital beds, home oxygen equipment, orthotics, prosthetics, power scooters (if needed in the home), diabetes self-testing equipment, and certain nebulizers.
- Medicare also covers certain prescription medication and supplies that you use with your DME, even if they are disposable or can only be used once. For example, Medicare covers medications used with nebulizers. Medicare also covers lancets and test strips used with diabetes self-testing equipment.
- More info: Types of medical equipment Medicare covers for home use - from Medicare Interactive
- Medicare does NOT cover:
- Equipment mainly intended to help you outside the home. For example, if you can walk on your own for short distances—enough to get you around inside your house—Medicare does not cover a motorized scooter that you only need outside the home.
- Most items intended only to make things more convenient or comfortable. This includes stairway elevators, grab bars, air conditioners, and bathtub and toilet seats.
- Items that are thrown away after use or that are not used with equipment. For example, Medicare does not cover incontinence pads, catheters, surgical facemasks, or compression leggings. However, if you receive home health care, Medicare pays for some disposable supplies—including intravenous supplies, gauze, and catheters—as part of your home health care benefit.
- Note: catheters may be covered as prosthetics if you have a permanent condition.
- More info: Equipment and supplies excluded from Medicare coverage - from Medicare Interactive
(Source: Medicare Rights Center)
Prior Authorization -
Centers for Medicare & Medicaid Services (CMS) expanded the list of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that require pre-authorization as a condition of payment. For more information, see Changes to Medicare Prior Authorization for DME Coming Soon
- MGH Community News, May 2019
Competitive Bidding
Competitive Bidding- More Info (2013 update) - *on hold starting January 2019. More below.
*Starting January 1, 2019, CMS will institute a two year "temporary gap" in its Competitive Bidding Supplier program for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS).
This means that for all of 2019 and 2020, Medicare beneficiaries in fee-for-service Medicare may purchase Medicare-covered DME from any Medicare-enrolled supplier. For more information, see this CMS fact sheet and this newsletter article.
When competitive bidding is active look here: Some Original Medicare members must use selected providers for certain DME. For the most up-to-date list of Medicare contract suppliers, visit Medicare.gov/supplier and enter the ZIP code. Select the product category of the item you need to view or print a list of Medicare-contract suppliers you can use. Or, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. A customer service representative can help you find a supplier.
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- Equipment Reuse and Loan Programs
(For those without insurance coverage)
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Medical Equipment Loan & Reuse Options (MA) - MassMatch (MA Rehabilitation Commission)
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REquipment - Medical equipment recycling program that provides individuals and families in Greater Boston and Central Massachusetts with gently-used, refurbished durable medical equipment (DME).
Contact: info@dmerequipment.org, 617-204-3626 or 866-244-6156 Toll Free
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Pass It On, Inc - closed in 2021
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Muscular Dystrophy Association (MDA) - Provides recycled wheelchairs and other DME for long-term loan. Individuals must have a prescription for the DME due to a neuromuscular disease. Equipment should be returned when no longer needed.
Contact: 978-720-2800
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Wheelchair Recycler, Inc
9 Summer St, Ashland
Their mission is to mobilize those in need by recycling and refurbishing used power wheelchairs and scooters.
Contact: 508-460-6328
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M.O.R.G.A.N. Project
Support for parents of special needs children, including equipment and grants. This organization offers an online equipment exchange program.
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Freecycle - A nonprofit network of people giving and getting free items in their local communities, including assistive technology.
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Equipment Resource Guide from Mystic Valley Elder Services
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Independent Living Centers and
regional elder agencies (ASAPs) may have equipment available for loan.
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Local cities/towns may also have programs through the municipality or local community groups. Try contacting the city/town hall.
- South of Boston
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Ayers Handicap Conversion Center
Offers donated durable medical equipment for loan to residents of Quincy and the South Shore.
Contact: 617-328-0102
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Scituate Etrusco Associates
1 Common Street, Scituate
Offers 3-month loans with 1-month extension (Companion chairs limited to 30 days). Annual dues: $1.00. Equipment includes walkers, canes, wheelchairs, beds, commodes, tub benches, etc.
Contact: Robert Gallagher - President, 781-545-4411
- North of Boston
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Hospital Equipment Loan Program (HELP) - Offers DME free of charge. Open Saturdays 9:00 a.m. to 12:00 p.m., 500 West Cummings Park, Woburn. No need to be a Freemason. Equipment available on a first-come, first-served basis. Delivery not guaranteed.
- Jenks Center - Council on Aging
109 Skillings Road, Winchester
Seniors may borrow equipment indefinitely, not limited to Winchester residents. Equipment must be picked up. Availability varies.
Contact: Sheryle Burditt - COA Nurse, 781-721-7136, nursecoa@yahoo.com
- Metro-West
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Needham Community Council, Inc
51 Lincoln Street, Needham
Lends equipment to residents for up to 6 months. Available items include crutches, wheelchairs, walkers, and bath seats.
Contact: Sandra Robinson - Executive Director, 781-444-2415
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Wellesley Friendly Aid Association
Walkers, commodes, shower chairs, and wheelchairs available to residents upon request. No charge.
Contact: 781-235-3960
- Grants and Other Funding Sources
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Grants for Individuals
From the Christopher Reeve Foundation website. Many of these grants are specific to those who have suffered a spinal cord injury.
- Specialized Classified Ads
- Veterans
- Wheelchair Repair
- Also see:
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