HI 00610.190 Rental and Purchase of Durable Medical Equipment (DME)
Rental or purchase of durable medical equipment (DME) is reimbursable if the following three requirements are met. It is the beneficiary's decision whether to rent or purchase an item.
The equipment meets the definition of DME (HI 00610.200); and
The equipment is necessary and reasonable for the treatment of the patient's illness or injury or to improve the functioning of his malformed body member (HI 00610.210); and
The equipment is used in the patient's home.
B. Definition of beneficiary's home
For purposes of rental and purchase of DME, a beneficiary's home may be his own dwelling, an apartment, a relative's home, a home for the aged, or some other type of institution may not be considered a beneficiary's home if it:
Meets at least the basic requirement in the definition of a hospital; i.e., it is primarily engaged in providing by or under the supervision of physicians, to inpatients, diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, and sick persons, or rehabilitation services for the rehabilitation of injured, disabled, or sick persons or
Meets at least the basic requirement in the definition of a skilled nursing facility; i.e., it is primarily engaged in providing to inpatients skilled nursing care and related services for patients who require medical or nursing care, or rehabilitation services for the rehabilitation of injured, disabled, or sick persons.
Thus, if an individual is a patient in an institution or distinct part of an institution which provides the services described in 1. or 2. above, he is not entitled to have payment made for rental or purchase of DME since such an institution may not be considered his home.
Payment may also be made for repairs, maintenance, and delivery of equipment as well as for expendable and nonreusable items essential to the effective use of the equipment subject to the conditions in HI 00610.220.
When covered DME is furnished to a beneficiary by a supplier of services other than a provider of services, reimbursement is made by the carrier on the basis of the reasonable charge. If the equipment is furnished by a provider of services, reimbursement is made to the provider by the intermediary on the basis of whichever is lower; the provider's customary charge or the reasonable cost of the covered services.