If you need durable medical equipment in your home, Medicare requires your doctor or treating practitioner (such as a nurse or physician assistant) to prescribe the type of equipment you need. For some equipment, Medicare also requires your doctor or one of the doctor’s office staff to fill out a special form, called a Certificate of Medical Necessity, and send it to Medicare for approval.
Your durable medical equipment supplier will work with your doctor to see that all required information is submitted to Medicare. If your prescription and/or condition changes, your doctor must complete and submit a new, updated certificate.
Medicare only covers durable medical equipment from suppliers enrolled in the Medicare Program. This means that the supplier has been approved by Medicare and has a Medicare supplier number. To find a supplier enrolled in the program, visit www.medicare.gov and select “Find Suppliers of Medical Equipment in Your Area.” You can also call 1-800-MEDICARE (1-800-633-4227) to get this information.
A durable medical equipment supplier enrolled in the Medicare Program must meet strict standards to qualify for a Medicare supplier number. If your supplier doesn’t have a supplier number, Medicare will not pay your claim, even if your supplier is a large chain o department store that sells more than just durable medical equipment.
What Medicare Covers
- Air fluidized beds
- Blood glucose monitors
- Bone growth (or osteogenesis) stimulators*
- Canes (except canes for the blind)
- Commode chairs
- Home oxygen equipment and supplies*
- Hospital beds
- Infusion pumps and some medicines used in them
- Lymphedema pumps/pneumatic compression devices*
- Nebulizers and some medicines used in them (if reasonable and necessary)
- Patient lifts*
- Suction pumps
- Traction equipment
- Transcutaneous electronic nerve stimulators (TENS)*
- Ventilators or respirator assist devices
- Wheelchairs (manual and power)
*You must get a Certificate of Medical Necessity before you can purchase this equipment.
What You Pay
Generally, you pay 20% of the Medicare-approved amount after you pay your Medicare Part B deductible for the year. Medicare pays the other 80%. The Medicare-approved amount is the lower of the actual charge for the item or the fee Medicare sets for the item. However, the amount you pay may vary because Medicare pays for different kinds of durable medical equipment in different ways. You may be able to rent or buy the equipment.