Site Map Basic Needs Populations

Health
& Illness

Legal MGH
Resources 		Reference Newsletter Excellence Every Day

   

Staff Access
Basic Needs
Basic Needs

Health Care Coverage
Durable Medical Equipment (DME)
   

Skip to:


      Patient Handouts from the CRC

    Definition

    Durable medical equipment (DME) is equipment that provides therapeutic benefits to a patient in need because of certain medical conditions or illnesses and can stand repeated use. It may include a variety of items such as walkers, wheelchairs, power scooters, hospital beds and oxygen tanks (not a complete list).

    Insurance Coverage

    DME suppliers can help to determine if insurance will cover DME. More information below.

  • MassHealth

    • DME vendors/providers now submit the prior authorization to MassHealth. They will work with the physician to get necessary paperwork such as a letter of medical necessity a prescription, and other supporting documentation. For inquiries related to a procedure or treatment that requires prior authorization (PA), providers should call 1-800-862-8341 (for all services except pharmacy, dental, non-emergency transportation).
      • In June 2018, MassHealth introduced PA functionality to the LTSS Provider Portal for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) and Oxygen and Respiratory Therapy Equipment. Beginning February 1, 2019, all DMEPOS providers will no longer be able to submit their MassHealth PAs through the Provider Online Service Center (POSC) and must use the LTSS Provider Portal. The LTSS Provider Portal: https://www.masshealthltss.com. If you need assistance, please contact the LTSS Provider Service Center at 1-844-368-5184 or support@masshealthltss.com. Also see the 2018 DME Provider Portal Training Guide for assistance.
    • MassHealth DME regulations- Covered DME services- see section 409.413: Covered Services (page 4-9) and Non-Covered DME services - see section 409.414: Noncovered Services (page 4-10).
      • Bath and toilet equipment and supplies (commodes, grab bars, tub benches, etc.) and Patient Lifts are covered
      • Home or vehicle modifications, such as ramps, elevators, or stair lifts are not covered.
    • MassHealth DME and Oxygen Payment and Coverage Guidelines Tools

     

  • Medicare
    • Medicare usually covers DME if the equipment is:
      • Durable, meaning you can use it again (excludes items like incontinence pads, catheters, etc.)
      • Designed to help a medical condition or injury;
      • Suitable to use in the home, although you can also use it outside the home; and
      • Likely to last for three years or more.

    • Medicare will only cover the cost of your DME if your doctor prescribes it and certifies that you need it to get around your home, not just to get around outside of your home.
    • Some examples of DME covered by Medicare are walkers, crutches, wheelchairs, power scooters, seat lifts, hospital beds, home oxygen equipment, orthotics, prosthetics, power scooters (if needed in the home), diabetes self-testing equipment, and certain nebulizers.
      • Medicare also covers certain prescription medication and supplies that you use with your DME, even if they are disposable or can only be used once. For example, Medicare covers medications used with nebulizers. Medicare also covers lancets and test strips used with diabetes self-testing equipment.
      • More info: Types of medical equipment Medicare covers for home use - from Medicare Interactive
    • Medicare does NOT cover:
      • Equipment mainly intended to help you outside the home. For example, if you can walk on your own for short distances—enough to get you around inside your house—Medicare does not cover a motorized scooter that you only need outside the home.
      • Most items intended only to make things more convenient or comfortable. This includes stairway elevators, grab bars, air conditioners, and bathtub and toilet seats.
      • Items that are thrown away after use or that are not used with equipment. For example, Medicare does not cover incontinence pads, catheters, surgical facemasks, or compression leggings. However, if you receive home health care, Medicare pays for some disposable supplies—including intravenous supplies, gauze, and catheters—as part of your home health care benefit.
        • Note: catheters may be covered as prosthetics if you have a permanent condition.
      • More info: Equipment and supplies excluded from Medicare coverage - from Medicare Interactive

          • (Source: Medicare Rights Center)

      Prior Authorization - Centers for Medicare & Medicaid Services (CMS) expanded the list of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that require pre-authorization as a condition of payment. For more information, see Changes to Medicare Prior Authorization for DME Coming Soon - MGH Community News, May 2019

      Competitive Bidding

      Competitive Bidding- More Info (2013 update) - *on hold starting January 2019. More below.

      *Starting January 1, 2019, CMS will institute a two year "temporary gap" in its Competitive Bidding Supplier program for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). This means that for all of 2019 and 2020, Medicare beneficiaries in fee-for-service Medicare may purchase Medicare-covered DME from any Medicare-enrolled supplier. For more information, see this CMS fact sheet and this newsletter article.

      When competitive bidding is active look here: Some Original Medicare members must use selected providers for certain DME. For the most up-to-date list of Medicare contract suppliers, visit Medicare.gov/supplier and enter the ZIP code. Select the product category of the item you need to view or print a list of Medicare-contract suppliers you can use. Or, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. A customer service representative can help you find a supplier.

     

  • Equipment Reuse and Loan Programs (for those without insurance coverage)

     

    • The Muscular Dystrophy Association (MDA) provides recycled wheelchairs and other DME for long term loan. Individuals requesting equipment must have a prescription for the DME due to a neuromuscular disease. Should the DME no longer be needed, individuals or their families are encouraged to return it to MDA for use by others.
      Contact: Andrew Bunyard 978-720-2800.

    • Wheelchair Recycler Inc
      9 Summer st
      Ashland MA 01721
      The Wheelchair Recycler’s mission is to provide any means necessary to mobilize those in need. This is accomplished through recycling, refurbishing and reclaiming used electric power wheelchairs and scooters as well as other durable medical equipment.
      Contact:       (508) 460-6328
      http://wheelchairrecycler.org/contact-us/

    • M.O.R.G.A.N. Project
      Support for parents of special needs children including equipment and grants.
      **This organization has an online equipment exchange program

    • Freecycle is a grassroots and entirely nonprofit movement of people who are giving (& getting) stuff for free in their own towns, including AT. Each local group is moderated by a local volunteer. Membership is free. Go to Freecycle to learn more.

    • Equipment Resource Guide from Mystic Vally Elder Services

    • Independent Living Centers and regional elder agencies (ASAPs) may have equipment available for loan.
      •  
    • Local cities/towns may also have programs either through the municipality itself or local community groups. Try contacting the city/town hall. 

      •

         

    South of Boston

      • Ayers Handicap Conversion Center - Donated durable medical equipment (wheelchairs, crutches, walkers, canes, special bathroom equipment and other ambulatory healthcare aids) are available for loan to residents of Quincy and the South Shore (Scituate, Hanover, Pembroke, Hull, Hingham, Norwell, Marshfield and Cohassett). Helping Hand is free thanks to the generosity of people who have donated the equipment they no longer need.
        617-328-0102.

        •  

      • Scituate Etrusco Associates
        1 Common Street, Scituate
        Loan for 3 months with an extension of one more month possible (with the exception of
        • “Companion chairs” light, foldable wheelchairs that are lent for 30 days only). Annual membership dues: $1.00. Equipment available: walkers, canes, wheelchairs, beds, commodes,bed side tables, crutches, tub benches, trapezes, bicycles. Eligibility for residents of Scituate, Hanover, Pembroke, Hull, Hingham, Norwell, Marshfield, Cohasset & Duxbury
        Contact:Robert Gallagher - President, (781) 545-4411

    North of Boston

      • Hospital Equipment Loan Program (HELP) - DME is available to borrow free of charge for home use. You do not have to be a Freemason to borrow equipment. Equipment for loan typically includes canes, commodes, tub seats, walkers, wheelchairs, transfer benches, hospital beds, possibly lifts. HELP is open Saturday mornings - 9 a.m. to 12 noon only, at 370 Salem Street in Wakefield. Equipment is first-come, first-served; they are not able to reserve equipment. Delivery- not routinely offered; different answers at different times.
        Brother Geoff Bemiss 781-322-1052- this is the warehouse number; only staffed Saturdays 9-12.         His personal residence number is 978-664-5131 (for staff use only). (Revised 5/13)

     

      • Jenks Center - Council on Aging
        109 Skillings Road, Winchester
        Seniors may borrow equipment indefinitely. Not limited to those from Winchester. Have walkers, canes, wheelchairs and commodes. Depend on donations of used equipment; some equipment may be out on loan, so availability varies. Users must pick up equipment.
        Contact: Sheryle Burditt - (COA Nurse)(781) 721-7136, nursecoa@yahoo.com

    Metro-West

    • Needham Community Council, Inc.
      51 Lincoln Street, Needham
      Lends any Needham resident medical equipment at no charge, for up to six months. Among the items available are crutches, wheelchairs, walkers, commodes and bath seats. A light weight wheelchair can be borrowed for a day or for up to 2 weeks. If you have any questions about the availability of equipment (listed or not) , please call. Items can be picked up at office weekdays from 8:30 a.m. to 4:00 p.m.
      Contact: Sandra Robinson - Executive Director, (781) 444-2415      .

    • Wellesley Friendly Aid Association- Walkers, commodes, shower chairs, wheelchairs and other specialty equipment are available to town residents upon request, at no charge to the user.  Please contact the Wellesley Friendly Aid office at (781) 235-3960. Donations of wheelchairs, walkers, and shower seats/benches are welcome.

     

    Also see: