Original Medicare (Parts A & B): Durable Medical Equipment (DME)

Durable medical equipment (DME)

DME is equipment, devices, and supplies that are reusable and generally not disposable. While walkers or wheelchairs and grab bars are common examples, the range of DME is much broader. It comprises everything from raised toilet seats to hospital beds and home modifications.

DME is ordered by a provider for medical reasons such as safety, treatment or therapy, or to improve quality of life.  Examples include walkers, wheelchairs, crutches, powered mattress systems, diabetic supplies, infusion pumps, speech-generating devices, oxygen equipment, nebulizers, or hospital beds ordered by a provider for use in the home.

All medically necessary DME is covered.  If the participating Medicare supplier in the area does not carry a particular brand or manufacturer preferred by the provider, a special order can be requested.

Prosthetics and Orthotics

Prosthetic devices are devices (other than dental) that replace all or part of a body part or its function. For example, a pacemaker replaces the electrical signals in the heart, orthotic shoes replace structures in the feet that are missing or damaged, and a colostomy replaces part of the bowel.

• Braces for ankle, foot, knee, back, neck, spine, hand, wrist, elbow

• Artificial eyes

• Artificial limbs

• A surgical brassiere after mastectomy, and some types of breast prostheses

• Devices to replace an internal body organ or function of the organ (colostomy supplies, oral and intravenous nutrition, pacemakers, and more).

• Orthopedic shoes as a necessary part of a leg brace

Also included are certain supplies related to prosthetic devices and repair and/or replacement of prosthetic devices. There may also be some coverage following cataract removal or cataract surgery. 

Medicare Participation

It is important to ask a provider and suppliers if they participate in Medicare before getting an order for DME. To receive the DME benefits, the provider or the supplier who offers the DME must be enrolled in Medicare.

If suppliers are participating suppliers, they must accept assignment (which means they can only charge the coinsurance and Part B deductible for the Medicare-approved amount). If DME suppliers are not Medicare-participating and don't accept assignment, there's no limit on the amount they can charge.

DME, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program

If the member lives in or visits a competitive bidding area and needs an off-the-shelf back or knee brace that is included in the DMEPOS program, they generally must use specific suppliers called "contract suppliers" if they want Medicare to help pay for the item. Contract suppliers are required to provide the item and accept assignment as a term of their contract with Medicare.

To see if the member lives in or visits a competitive bidding area, or to find suppliers who accept assignment, click here.