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Repair, Maintenance, and Replacement of Durable Medical Equipment (DME)

Section: Durable Medical Equipment
Effective Date: March 01, 2020
Revised Date: January 22, 2020
Last Reviewed: January 22, 2020

Description

Durable medical equipment (DME) is equipment that can withstand repeated use, is primarily and customarily used to serve a medical purpose, is generally not useful to a person in the absence of illness or injury, and is appropriate for use in the home.

Criteria

Under the circumstances specified below, benefits may be allowed for repair, maintenance, and replacement of medically required durable 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

Procedure Codes

K0462 K0739

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