Replacement of Durable Medical Equipment

Original Effective Date: 07/01/2001
Revision Effective Date: 11/01/2013

Medicare covers replacement of durable medical equipment (DME) that the beneficiary owns or is purchasing when:

  • the item is lost or irreparably damaged; or,
  • the item is worn beyond repair; or,
  • the patient's medical condition changes such that the current equipment no longer meets the patient's medical need(s).

Claims involving replacement equipment necessitated because of wear or a change in the patient's condition must be supported by a current physician's order.

Occasionally, an accessory required for the effective use of a DME item is irreparably worn and the replacement part needed is no longer available and cannot be substituted with another manufacturer's part. In those circumstances, the DME item itself must be replaced. For example, a transcutaneous electrical nerve stimulator (TENS) unit's lead wires are no longer manufactured and cannot be substituted with another brand. Therefore, the TENS unit itself is effectively nonfunctional and must be replaced. In these situations, the supplier must obtain and submit with the claim a current detailed written physician's order with an explanation of why the item must be replaced. For items that require a Certificate of Medical Necessity (CMN), a current CMN may serve as the detailed written order if the narrative description in Section C is sufficiently detailed.

            Last Updated Thu, 11 May 2017 12:44:25 +0000