Noncovered Items - JA DME
Noncovered Items
In order for an item to be covered by the Durable Medical Equipment Medicare Administrative Contractor (DME MAC), it must fall within a benefit category. Medicare Part B covered services processed by the DME MAC fall into the following benefit categories specified in Section 1861(s) of the Social Security Act:
Benefit Categories
- Durable medical equipment (DME)
- Prosthetic devices (artificial legs, arms, and eyes, including replacement prostheses)
- Leg, arm, back and neck braces (orthoses)
- Surgical dressings
- Immunosuppressive drugs
- Intravenous Immune Globulin
- Lymphedema Compression Treatment Items
- Therapeutic shoes for diabetics
- Oral anticancer drugs
- Oral antiemetic drugs (replacement for intravenous antiemetics)
Some items may not meet the definition of a Medicare benefit or may be statutorily excluded. In order for a beneficiary to be eligible for DME, prosthetics, orthotics, and supplies reimbursement, the reasonable and necessary requirements set out in the related Local Coverage Determination (LCD) must be met. In addition, there are statutory payment requirements specific to each policy that must be met. This criterion will be identified in individual LCD-related Policy Articles as statutorily noncovered.
The Medicare National Coverage Determinations (NCD) Manual provides the Durable Medical Equipment (DME) Reference List identifying DME items and their coverage status.
