Page 131 - Business Development Orientation Binder

DME Categories, Definitions and Delivery Timeframes

DME Category/Items Medicare Coverage Criteria Definition Timeframe Delivery Target

Critical Needed to prevent a life-threatening situation and/or Within 1 day 90%
 Compressor Nebulizer Medically necessary to administer hospitalization within 24-48 hours
MEDS for COPD, Asthma – other Note: If patient is in referral status (whether referred
manual neb/metered dose inhaler from a medical facility or from the community), then
must be tried first. all critical items should be in the home prior to the
case being pre-admitted and delivery of these items
 Compressor Heavy Duty Same as above plus patient requires must be confirmed.
humidity due to heavy secretions-
must have trach. (Continuous
aerosol for constant mist to trach)

 Nebulizer (use with Patient has O2 therapy and requires
regulator/flowmeter) humidification of oxygen in
conjunction with heavy duty
compressor

 Portable O2 System Required for ambulation within the
home

 Stationary O2 System PO2 55 or less, SAO2 below 89 &
test performed w/in 2 days prior to
order

 Suction Pump Required for patients who have
difficulty raising and clearing
secretions secondary to other
condition (trach, surgery, cancer,
dysfunction of swallowing muscles)
12 caths/month without trach, 3/day
with trach
 Critical: Enteral Nutrition Patient has dysphagia cannot Needed to prevent life-threatening situation and/or Within 1 day
Products swallow-Long term (>3 months) hospitalization within 24-48 hours.
(Sole source of nutrition) dysfunction of structures that permit
food to reach small bowel or disease
which impairs digestion that requires
tube feeding to maintain patient’s
weight. Receives nutrition from a
feeding tube.

1. Admission DME Categories