Medicare DME

Medicare & Durable Medical Equipment (DME)

This does not apply to members enrolled in HMO or MA PPO plans - if you are enrolled in one of these plan types, you should contact your health plan carrier for information about your specific DME benefits.

On July 1, 2013, Medicare implemented significant changes to the structure of its supplier network for Durable Medical Equipment, Prosthetics, Orthotics, and supplies (DMEPOS) under their “Competitive Bidding Program,” while also implementing a national mail order program for diabetic testing supplies. Medicare began this program in certain areas in January, 2011. This is an extension – or “Phase II” – of this program.

The program changes the amount Medicare pays suppliers for certain durable medical equipment, prosthetics, orthotics and supplies. It also changes who can supply these items. In order for Medicare to help pay for these items, original Medicare members will almost always have to use a Medicare contract supplier. In early May 2013, CMS mailed all Medicare members a letter notifying them of this change.

To find an approved supplier near you, Blue Cross Blue Shield members can call 888-722-0322. All others can call the number referenced on the back of their health plan ID card.

 

The following is a list of durable medical equipment, prosthetics, orthotics and supplies included in the competitive bidding program:

  • Oxygen, oxygen equipment, and supplies
  • Standard power wheelchairs, scooters, and related accessories
  • Complex rehabilitative power wheelchairs and related accessories
  • Mail-order diabetic supplies (all zip codes are affected)
  • Enteral nutrients, equipment, and supplies
  • Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs), and related supplies and accessories
  • Hospital beds and related accessories
  • Walkers and related accessories
  • Support surfaces (Group 2 mattresses and overlays)
Additionally, Medicare members must use an approved mail order or retail supplier for diabetic testing supplies (lancets, testing strips and monitors). In early May 2013, CMS mailed all Medicare members a letter notifying them of this change.

For more information, click here.