Criteria
Under the circumstances specified below, benefits may be allowed for repair, maintenance, and replacement of medically required home medical equipment which the individual owns or is purchasing:
- Repairs - Repairs are covered when necessary to make the equipment serviceable. The repair charge may include the use of loaner equipment where this is required. When the charge for the loaner equipment is not included in the repair charge, code K0462 (temporary replacement for individual-owned equipment being repaired, any type) should be used.
- Maintenance - Routine periodic servicing, such as testing, cleaning, regulating, and checking of the equipment is not covered. However, more extensive maintenance which, based on the manufacturers' recommendations, is to be performed by authorized technicians, would be covered as repairs.
- Replacement - Replacement of equipment is covered in cases of loss or irreparable damage or wear and when required because of a change in the individual’s condition. Reasonable Useful Lifetime (RUL) is the expected minimum lifespan for HME. In general, the RUL for HME is established as 5 years. Replacement of HME is covered when the RUL has been met.
Benefits are not available for repair, replacement or upgrade of Home Medical Equipment if items are damaged, destroyed, lost or stolen due to misuse, abuse or carelessness. No benefits are available for replacement or upgrade of Home Medical Equipment when requested for convenience or to upgrade to a newer technology when the current components remain functional.
Procedure Codes
