Disposable Medical Supplies/Durable Medical Equipment


January 1, 2013
131 Pages - SKU: APO4938644
License type:
Table of Contents Related Reports
An important UM resource tool. 
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.


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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