| Hundreds of specific review criteria for supply and DME Items, plus an alpha list with explanatory recommendation for basis to deny or approve for payment based on usual coverage 'medical necessity' determinations.
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- Preface, Disclosure, Copyright Information;
- Coverage and Payment Rules;
- Disposable medical supplies ;
- Diabetic supplies
- Incontinence supplies;
- Ostomy supplies;
- Surgical dressings
- Unna boot;
- Urological supplies
- Durable Medical Equipment (DME)
- Definitions
- Ambulatory blood Pressure Monitor;
- Ambulatory electrocardiography: Cardiac event monitors, Holter monitors,
- Implanted loop recorders, Mobile cardiac outpatient telemetry;
- Anodyne® (near-infrared) Therapy for Peripheral Neuropathy or Any Condition
- Apnea monitor;
- ART device
- Bathroom and Toilet Equipment and Supplies;
- Commodes;
- Beds/Pressure Reducing Support Surfaces - Introduction;
- Pressure Reducing Support Surfaces - Group 1;
- Pressure Reducing Support Surfaces - Group 2 and 3;
- Air Fluidized Beds ;
- Hospital beds;
- Bed accessories: Trapeze bars; Bed and Pillow Covers for Asthmatics;
- Bed-wetting Alarm;
- Breast Pumps;
- Cardiac Defibrillators, home use
- Catheters, Urinary;
- Traction devices; Cervical traction;
- Traction for low back pain;
- Chairs, therapeutic;
- Gravity lumbar reduction chairs
- Communication devices/aides; Speech generating devices
- Tracheo-esophageal voice prostheses, Indwelling;
- Augmentive communication aides; Communication board;
- Compression Garments in the Treatment of Venous Stasis Ulcers;
- Continuous passive motion device;
- Cooling devices;
- Cranial Remodeling Band/Helmet for infants with asymmetrical heads;
- Diabetes mellitus related DME;
- Glucose monitors, blood;
- Continuous Glucose Monitoring;
- External insulin pumps;
- GlucoWatch® Biographer;
- H-wave stimulation for the treatment of diabetic neuropathy
- Jet Injectors for Insulin Administration;
- Insulin Pens; Insulin syringes;
- Shoes, therapeutic;
- Sleep sentry to detect hypoglycemia;
- Diathermy;
- Electrical Stimulation Modalities
- Dorsal Column Stimulators/Spinal Cord Stimulators: Chronic pain, Angina pectoris;
- Neuromuscular electrical stimulation (NMES) for disuse atrophy;
- Treatment of Motor Function Disorders with Electric Nerve Stimulation - Medicare NCD;
- Neuromuscular or Therapeutic Electrical Stimulation (TES);
- Transcutaneous electrical nerve stimulation (TENS);
- Supplies - Form-fitting Conductive Garment for TENS or NMES;
- TENS - Medicare LMRPs;
- Inferential current stimulation;
- Non-Implantable Pelvic Floor Electrical Stimulator;
- ReliefBand;
- ‘Sympathetic Therapy’;
- Percutaneous electrical nerve stimulation (PENS);
- Implanted Peripheral Electrical Nerve Stimulation - Medicare LMRP;
- Electrical Stimulation/Electro-magnetic Therapy for the Treatment of Wounds: Chronic Stage III & IV Musculo-Cutaneous Ulcerations;
- Electrogalvanic Stimulators for Levator Syndrome;
- Environmental Control Systems;
- Vaporizers;
- Exercise Equipment;
- Hearing aids
- Bone-anchored Hearing Aid;
- Infusion pumps, external; implantable;
- Intra-oral appliances for the management of headache syndromes, TMJ
- Jobst burn garments;
- Lifts: Seat and Patient ;
- Light Emitting Diode (LED) or Infrared Therapy
- Light therapy/phototherapy for seasonal affective disorder
- Lymphedema ‘pump’/Manual lymph drainage;
- Magnetic Pelvic Floor Stimulation (MPFS) or Extracorporeal Magnetic Innervation (ExMI) therapy for Incontinence
- Mobility Assistive Equipment: Strollers; Walkers/Rollers; Wheelchairs, Power-type and Power-operated vehicles (POVs); INDEPENDENCE iBOT 4000 Mobility System; Wheelchair seats, cushions and back supports
- Pulmonary DME: Airway Clearance/High Frequency Chest Wall Oscillation Devices; Mechanical in-exsufflation/in-exsufflator devices; Intrapulmonary Percussive Ventilator (IPV); Nebulizers; Oxygen coverage including portable, home oxygen; Peak expiratory flow meters; postural drainage; Respiratory assist devices; Suction pumps; vaporizers
- Obstructive Sleep Apnea (OSA) Therapies: CPap for OSA; Noninvasive positive-pressure ventilation (NPPV)/Bilevel Positive Airway Pressure (BiPAP); Sleep Apnea, Noninvasive Positive Pressure Ventilation (NPPV)/Bi-PAP, C-PAP - References/resources; Palatal implants for obstructive sleep apnea (OSA).
- Wound Care: Electrical Stimulation/Electro-magnetic Therapy for the Treatment of Wounds: Chronic Stage III & IV Musculo-Cutaneous Ulcerations; Negative pressure wound therapy (NPWT) Pumps; Noncontact Normothermic Wound Therapy/Radiant Heat Wound Therapy Systems; Pneumatic Compression Therapy/Circulator Boot - End-diastolic for extremity ulcers, lymphedema
- Orthotic (braces) and Prosthetic Devices; CERT document checklist links
- Aircast ankle brace
- Breast prosthesis, specialized bras for women post-mastectomy
- Canes and crutches
- Corsets
- Dynamic Splinting Devices;
- Facial prostheses
- Foot Orthotics/Prosthetics; Shoe(s), Therapeutic;
- Hand neuroprosthesis
- Hernia Truss/Sykes;
- Knee braces
- Lower limb prostheses, above-knee, computerized
- Magnetic insoles for plantar heel pain
- Magnetic Pelvic Floor Stimulation (MPFS);
- Myoelectric prosthesis, upper extremity;
- Lower limb computerized prosthesis
- Prosthesis criteria: functional levels
- Scoliosis Braces
- Spinal Orthoses - TLSO, LSO
- Spinal Unloading Devices
- Splints, Strapping & Casting
- Pneumatic Compression Therapy - End-diastolic for non-healing extremity ulcers;
- Peak expiratory flow meter;
- Prothrombin Time - Home Testing Systems/Coagulometers;
- Safety items for patient use
- ThairapyÒ vest for cystic fibrosis; Thairapy Bronchial Drainage System;
- Therabite® Jaw Motion Rehabilitation System;
- Sexual Function Restorative Devices;
- Male: Non-invasive suction or vacuum constriction devices; Penile prosthesis implantation
- Female
- Standers, Boards and Tilt Tables;
- Ultraviolet B Home Therapy;
- Vitrectomy Face Support;
- Whirlpool;
- Wigs;
- DMS/DME Miscellaneous List - Review criteria for 275 additional items;
- Addenda
- Web Resources
- Reuse Information Resource
- Medicare Advance Beneficiary Notice and Limits on Beneficiary Liability for DMS/DME;
- Accreditation organizations for suppliers of durable medical equipment, prosthetics, orthotics and supplies
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