HI 00610.220 Repairs, Maintenance, Replacement and Delivery

Under the circumstances specified below, payment may be made for repair, maintenance, and replacement of medically required DME which the beneficiary owns or is purchasing, including equipment which had been in use before the user enrolled in Part B. Since renters of equipment usually recover from the rental charge the expense they incur with respect to maintaining in working order the equipment they rent, separately itemized charges for repair, maintenance and replacement of rented equipment are not covered.

A. Repairs

Repairs to equipment which a beneficiary is purchasing or already owns are covered when necessary to make the equipment serviceable. If the expense for repairs exceeds the estimated expense of purchasing or renting another item of equipment for the remaining period of medical need, no payment can be made for the amount of the excess. (See C. below when claims for repairs suggest malicious damage or culpable neglect.) The repair charge may include the use of loaner equipment where this is required.

B. Maintenance

Routine periodic servicing, such as testing, cleaning, regulating and checking of the beneficiary"s equipment is not covered. Such routine maintenance is generally expected to be done by the owner rather than by a retailer or some other person who would charge the beneficiary. Normally, purchasers of DME are given operating manuals which describe the type of servicing an owner may perform to properly maintain the equipment. Thus, hiring a third party to do such work would be for the convenience of the beneficiary and would not be covered.

However, more extensive maintenance which, based on the manufacturers" recommendations, is to be performed by authorized technicians, is covered as repairs. This might include, for example, breaking down sealed components and performing tests which require specialized testing equipment not available to the beneficiary.

C. Replacement

Replacement of equipment which the beneficiary owns or is purchasing is covered in cases of loss or irreparable damage or wear and when required because of a change in the patient"s condition. Expenses for replacement required because of loss or irreparable damage may be reimbursed without a physician"s order when in the judgment of the carrier the equipment as originally ordered, considering the age of the order, would still fill the patient"s medical needs. However, claims involving replacement equipment necessitated because of wear or a change in the patient"s condition must be supported by a current physician"s order.

Cases suggesting malicious damage, culpable neglect or wrongful disposition of equipment as discussed in HI 00610.240 are investigated and denied when the carrier determines that it would be unreasonable to make program payment under the circumstances. The carrier refers such cases to the program integrity specialist in the CMS regional office.

D. Delivery

Reasonable charges for delivery of DME whether rented or purchased are covered if the supplier customarily makes separate charges for delivery and this is a common practice among the other local suppliers.

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HI 00610.220 - Repairs, Maintenance, Replacement and Delivery - 11/16/2001
Batch run: 11/16/2001