In order for an item to be covered by the Durable Medical
Equipment Medicare Administrative Contractor (DME MAC), it must fall within one
of ten benefit categories. 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:
- Durable
medical equipment (DME)
- Prosthetic
devices
- Leg,
arm, back and neck braces (orthoses) and artificial leg, arm and eyes,
including replacement (prostheses)
- Home
dialysis supplies and equipment
- Surgical
dressings
- Immunosuppressive
drugs
- Erythropoietin
(EPO) for home dialysis patients
- 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. The items listed below will always be denied as
non-covered. The Medicare National Coverage Determinations (NCD) Manual
provides a list of items that are noncovered with the reason for denial. The
following items will be denied as noncovered when submitted to the DME
MAC.
| HCPCS | DESCRIPTION |
|
A4210
|
Needle-free injection device, each |
|
A4250
|
Urine test or reagent strips or tablets (100 tablets or strips) |
|
A4490
|
Surgical stockings above knee length, each |
|
A4495
|
Surgical stockings thigh length, each |
|
A4500
|
Surgical stockings below knee length, each |
|
A4510
|
Surgical stockings full-length, each |
|
A4520
|
Incontinence garment, any type, (e.g. brief, diaper), each |
|
A4554
|
Disposable underpads, all sizes |
|
A4575
|
Topical hyperbaric oxygen chamber, disposable |
|
A4627
|
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
|
A6000
|
Non contact wound-warming wound cover for use with the non contact wound-warming device and warming card |
|
A6530
|
Gradient compression stocking, below knee, 18-30 mmHg, each |
|
A6533
|
Gradient compression stocking, thigh length, 18-30 mmHg, each |
|
A6534
|
Gradient compression stocking, thigh length, 30-40 mmHg, each |
|
A6535
|
Gradient compression stocking, thigh length, 40-50 mmHg, each |
|
A6536
|
Gradient compression stocking, full length/chap style, 18-30 mmHg, each |
|
A6537
|
Gradient compression stocking, full length/chap style, 30-40 mmHg, each |
|
A6538
|
Gradient compression stocking, full length/chap style, 40-50 mmHg, each |
|
A6540
|
Gradient compression stocking, waist length, 30-40 mmHg, each |
|
A6541
|
Gradient compression stocking, waist length, 40-50 mmHg, each |
|
A6542
|
Gradient compression stocking, custom made |
|
A6543
|
Gradient compression stocking, lymphedema |
|
A6544
|
Gradient compression stocking, garter belt |
|
A6549
|
Gradient compression stocking, not otherwise specified |
|
A9270
|
Noncovered item or service |
|
A9275
|
Home glucose disposable monitor, includes test strips |
|
A9276
|
Sensor; invasive (e.g. subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, one unit = 1 day supply |
|
A9277
|
Transmitter; external, for use with interstitial continuous glucose monitoring system |
|
A9278
|
Receiver (monitor); external, for use with interstitial continuous glucose monitoring system |
|
A9280
|
Alert or alarm device, not otherwise classified |
|
A9281
|
Reaching/grabbing device, any type, any length, each |
|
A9282
|
Wig, any type, each |
|
A9300
|
Exercise equipment |
|
B4100
|
Food thickener, administered orally, per ounce |
|
E0172
|
Seat lift mechanism placed over or on top of toilet, and type |
|
E0191
|
Heel or elbow protector, each |
|
E0203
|
Therapeutic lightbox, minimum 10,000 lux, table top model |
|
E0220
|
Hot water bottle |
|
E0230
|
Cap or collar |
|
E0231
|
Non-contact wound warming device (temperature control unit, AC adapter and power cord) for use with warming card and wound cover |
|
E0232
|
Warming card for use with the non-contact wound warming device and non-contact wound warming wound cover |
|
E0240
|
Bath/shower chair, with or without wheels, any size |
|
E0241
|
Bath tub wall rail, each |
|
E0242
|
Bath tub rail, floor base |
|
E0243
|
Toilet rail, each |
|
E0244
|
Raised toilet seat |
|
E0245
|
Tub stool or bench |
|
E0246
|
Transfer tub rail attachment |
|
E0247
|
Transfer bench for tub or toilet with or without commode opening |
|
E0248
|
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
|
E0270
|
Hospital bed, institutional type includes: oscillating, circulating and stryker frame with mattress |
|
E0273
|
Bed board |
|
E0274
|
Over-bed table |
|
E0315
|
Bed accessory: board, table, or support device, any type |
|
E0481
|
Intrapulmonary percussive ventilation system and related accessories |
|
E0625
|
Patient lift, bathroom or toilet, not otherwise classified |
|
E0637
|
Combination sit to stand system, any size including pediatric, with seatlift feature, with or without wheels |
|
E0638
|
Standing frame system, one position (e.g. upright, supine or prone stander), any size including pediatric, with or without wheels |
|
E0641
|
Standing frame system, multi-position (e.g. three-way stander), any size including pediatric, with or without wheels |
|
E0642
|
Standing frame system, mobile (dynamic stander), any size including pediatric |
|
E0700
|
Safety equipment (e.g., belt, harness or vest) |
|
E0710
|
Restraints, any type (body, chest, wrist or ankle) |
|
E0936
|
Continuous passive motion exercise device for use other than knee |
|
E1300
|
Whirlpool, portable (overtub type) |
|
J1055
|
Injection, medroxyprogesterone acetate for contraceptive use, 150 mg |
|
J3520
|
Edetate disodium, per 150 mg |
|
J3535
|
Drug administered through a metered dose inhaler |
|
J3570
|
Laetrile, amygdalin, vitamin B-17 |
|
J8499
|
Prescription drug, oral, nonchemotherapeutic, NOS |
|
J8515
|
Cabergoline, oral, 0.25 mg |
|
L0210
|
Thoracic rib belt |
|
L1800
|
Knee orthosis, elastic with stays, prefabricated |
|
L1815
|
Knee orthosis, elastic or other elastic type material, with condylar pads, prefabricated |
|
L1825
|
Knee orthosis, elastic knee cap, prefabricated |
|
L1901
|
Ankle orthosis, elastic, prefabricated |
|
L3651
|
Shoulder orthosis, single shoulder, elastic, prefabricated |
|
L3652
|
Shoulder orthosis, double shoulder, elastic, prefabricated |
|
L3700
|
Elbow orthosis elastic with stays, prefabricated |
|
L3701
|
Elbow orthosis, elastic, prefabricated |
|
L3909
|
Wrist orthosis, elastic, prefabricated |
|
L3911
|
Wrist hand finger orthosis, elastic, prefabricated |
|
L3215
|
Orthopedic footwear, ladies shoes, oxford, each |
|
L3216
|
Orthopedic footwear, ladies shoes, depth inlay, each |
|
L3217
|
Orthopedic footwear, ladies shoes, hightop, depth inlay, each |
|
L3219
|
Orthopedic footwear, mens shoes, oxford, each |
|
L3221
|
Orthopedic footwear, mens shoes, depth inlay, each |
|
L3222
|
Orthopedic footwear, mens shoes, hightop, depth inlay, each |
|
L7600
|
Prosthetic donning sleeve, any material, each |
|
Q0144
|
Azithromycin dehydrate, oral, capsules/powder, 1 gram |
|
V2025
|
Deluxe frame |
|
V2600
|
Hand held low vision aids and other nonspectacle mounted aids |
|
V2610
|
Single lens spectacle mounted low vision aids |
|
V2615
|
Telescopic and other compound lens system, including distance vision telescopic, near vision telescopes and compound microscopic lens system |
|
V2702
|
Deluxe lens feature |
|
V2760
|
Scratch resistant coating, per lens |
|
V5336
|
Repair/modification of augmentative communicative system or device (excludes adaptive hearing aid) |
