Article Detail - JD DME

Original Effective Date: 12/06/2001
Revision Effective Date: 11/01/2013

If a capped rental item of equipment has been in continuous use by the patient, on either a rental or purchase basis, for the equipment's useful lifetime or if the item is lost or irreparably damaged, the patient may elect to obtain a new piece of equipment. If the patient elects to obtain a new piece of equipment, payment is made on a rental or purchase basis or a lump-sum purchase basis if a purchase agreement has been entered into. Expenses for replacement required because of loss or irreparable damage will be reimbursed without a physician's order if the equipment as originally ordered still fills the patient's medical need. However, claims involving replacement equipment necessitated because of wear or change in the patient's condition must have a current physician's order.

Claims filed for the lump-sum purchase of the replacement item must be billed using E1399RP with the following documentation:

• Manufacturer's name for both the original piece of equipment and the replacement equipment
• Product name for both the original piece of equipment and the replacement equipment
• Date of purchase for the original piece of equipment
• A detailed explanation of why the original piece of equipment needs to be replaced

For example:

• When indicating replacement due to irreparable damage, indicate how the item was damaged (fire, flood, etc.)
• When indicating replacement due to loss, indicate the nature of the loss (theft, fire, etc.)
• When indicating replacement due to useful lifetime and cost of repairs, include an itemized breakdown of the estimated repairs necessary to return the original piece of equipment to working order with an explanation of why you feel this piece of equipment has exceeded it's useful lifetime.

Please include any documentation that may be beneficial in the coverage determination such as police, fire, or accident reports.

Publication History