Customized Items - JA DME

Coverage and allowable amounts for custom equipment will be decided by an individual evaluation based on medical indication. The beneficiary's physician must prescribe the customized equipment and provide information regarding the beneficiary's physical and medical status to warrant the need for the equipment. Payment with respect to a covered item that is uniquely constructed or substantially modified to meet the specific needs of an individual beneficiary should be made in a lump-sum amount.

The following items are needed for coverage to be considered:

• Detailed description of the item
• Description of feature(s) that make this item unique
• Acquisition or production cost of the item, i.e., line item cost of materials and/or labor

The date of service for custom-made equipment is the actual date the beneficiary receives the item. Do not use the date the item was ordered when billing Medicare.

Canceled Orders for Customized Items - When an order for a customized item is canceled, the beneficiary passes away before the scheduled delivery or the beneficiary's condition changed and the item is no longer reasonable and necessary or appropriate, suppliers are eligible for reimbursement for the labor and parts invested in the customization process.