Article Detail - JA DME

We receive many questions from suppliers regarding items that are noncovered. Please refer to the Noridian Noncovered Items webpage for information regarding these items. First, 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.

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 listed 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. These criteria will be identified in individual LCD-related Policy Articles (PAs) as statutorily noncovered.

A list of noncovered items is available on our website. The list is not all-inclusive. Some items are identified as noncovered or statutorily noncovered in the LCD or PA of individual policies.