Even though an item of DME may serve a useful medical purpose, the carrier also considers
whether it would be reasonable for the program to pay for the item. The following
considerations enter into the determination of reasonableness:
Would the expense of the item to the program be clearly disproportionate to the therapeutic
benefits which could ordinarily be derived from use of the equipment?
Is the item substantially more costly than a medically appropriate and realistically
feasible alternative pattern of care?
Does the item serve essentially the same purpose as equipment already available to
Claims for billed items of equipment found to be out of line with tests of reasonableness
are denied in full except in the following case: When it is determined that there
exists a medically appropriate and realistically feasible alternative pattern of care
for which payment could be made, payment is based on the reasonable charge for this