Durable medical equipment (DME) is equipment that aids in the performance of daily tasks. It has a range of products, including walkers, wheelchairs, and oxygen tanks. Medicare often covers DME if it meets the following criteria:
- Durable, i.e., capable of withstanding repeated usage
- Provides a medicinal benefit
- Although it is suitable for use in the home, it can also be used outside the home.
- And, is likely to endure for at least three years
For Part B coverage, DME must be recommended by your primary care physician (PCP). Part A covers DME if you are hospitalized or residing in a skilled nursing facility (SNF).
Regardless of whether you have Original Medicare or a Medicare Advantage Plan, Medicare should cover the same types of medical equipment. Examples of DME consist of:
- Wheelchairs
- Walkers
- Patient beds
- Electric scooters
- Oxygen transportable equipment
Medicare Part B also covers the following durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS):
- Internal prostheses that replace all or a portion of an organ
- The use of prosthetics, such as artificial legs, arms, and eyes
- Orthotics, such as stiff or semi-rigid braces for the leg, arm, back, and neck
Specific medical equipment
Medicare also covers prescription medications and supplies used in conjunction with DME, even if they are disposable or single-use. It covers drugs used with nebulizers, for example. Medicare also covers lancets and test strips utilized with self-testing equipment for diabetes.
Significance For Clinical Practice
Numerous physiological, physical, and mental benefits are related with the utilization of DME. For instance, DME enables persons to become more independent and reduces their need for caregiver help. With the opportunity for increasing independence, individuals with disabilities have a better capacity to improve their psychological health and social participation. Prior to recommending and purchasing specific equipment, there are a number of variables to consider, despite the fact that there are a number of purported benefits of using DME.
When establishing a patient’s need for DME, one must examine the patient’s diagnosis, functional impairments, and precautions in order to choose the most suitable equipment. It should be determined whether the goal of durable medical equipment is to boost independence through self-care and mobility or to reduce caregiver strain and improve safety. Consideration should also be given to the patient’s specific aspirations, home environment, and financial cost burden.
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Cognitive problems, such as diminished memory, diminished judgment, poor safety awareness, or a lack of self-awareness of disability, offer difficulties for medical personnel when training clients to incorporate DME into daily activities. For persons with cognitive disabilities, teaching a family member or caregiver can assure proper use, improve safety, and boost compliance. Individual cultural and societal biases may influence the impression of DME, either positively or adversely, and should be considered as a further element.
DME can provide aid with three primary rehabilitative activities in order to promote independence and safety. These include activities of daily living (ADLs), mobility, and transfers. ADLs include eating, grooming, bathing, dressing the upper extremities, dressing the lower extremities, and using the toilet. OTs play a crucial role in evaluating a patient’s capacity to do ADL chores, such as checking the patient’s safety during transfers to the toilet, tub, or shower.
Patients who have trouble rising from a seated posture, particularly from low surfaces. May benefit from the usage of a 3-in-1 commode chair or a raised toilet seat. Both enhance the height of the toilet seat and give handles for the individual to use when standing up from the toilet. Individuals with severe lower extremity weakness or paralysis who rely on a wheelchair for mobility and a transfer board for safe transfers would benefit more from a commode chair with drop arms.
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With a drop arm commode chair. The chair’s arms swing away or down to offer a flat surface for these persons’ safe lateral transfers. Additionally, a patient may utilize a shower chair with or without a backrest to conserve energy and reduce the chance of collapsing while bathing. Patients with hemiparesis, specific range of motion constraints, or reduced balance frequently require a tub transfer bench to enter and exit the tub securely. This permits the client to remain a seated position while maneuvering their lower extremities into and out of the tub. In addition to basic DME, a hand-held shower head, grab bars to be fitted in the shower and toilet area, and a floor-to-ceiling transfer pole may be recommended to increase bathroom safety.
When reviewing the criteria for durable medical equipment, hearing aids appear to be eligible. After all, you wear them daily, and they have a lifespan that exceeds three years. Unfortunately, they do not qualify as DME.
Hearing loss affects around 25% of individuals aged 65 to 75 and 50% of those aged 75 and beyond. However, hearing aids are still not considered durable medical equipment and are not covered by Medicare or the majority of private insurers.
Hearing aids are instead categorized as Class I, or optional, medical devices.
Class, I medical equipment is not medically necessary by definition. Hearing aids do not qualify since DME only covers medically required equipment. If you are concerned about the expense of hearing aids because they are not considered Medicare-approved durable medical equipment, see the video below. Brad Ingrao, an audiologist, discusses how to obtain hearing aids at no or low cost.
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