Page 132 - Business Development Orientation Binder

DME Categories, Definitions and Delivery Timeframes

DME Category/Items Medicare Coverage Criteria Definition Timeframe Delivery Target

Urgent Needed to avoid serious deterioration of patient’s Within 2 days 90%
 Hospital Bed (fixed or Medical condition requires condition
variable height/with side positioning not feasible in ordinary Note: If patient is in Referral status (whether referred
rails) & Manual Controls bed- to alleviate pain, and or head from a medical facility or from the community) or in
required to be elevated > 30 degrees, Interruption of Care status due to hospitalization and
or traction required, and requires ready to be discharged) the Home Care Consultant or
frequent change in body position the Admission Nurse must confirm the delivery of the
(need cardiac and or respiratory item prior to patient discharge
condition for electronic bed).

 Enteral Nutrition Products Not covered under medicare.
(Supplemental source of
nutrition)

Urgent-Support Surfaces Medicare requires MD Letter of Needed to avoid serious deterioration of patient’s Within 3 days 90%
Medical Necessity prior to delivery condition
of any support surface Note: If patient is in Referral status (whether referred
from a medical facility or from the community) or in
 Pressure Mattress Multiple stage 2 or stage 3 decubitis Interruption of Care status due to hospitalization and
(alternating pressure or low ready to be discharged) the Home Care Consultant or
air loss) the Admission Nurse must confirm the delivery of the
item prior to patient discharge.

 Pressure pad/alternating Stage 1 or prevention for patient at
with pump, foam/gel high risk of breakdown
replacement or overlay

 Jay Cushion/ ROHO Patient must have a wheelchair (no
Cushion/ Wheelchair cushion ordered previously). Highly
Cushion, 2,3 or 4 inch susceptible to decubitus, chairbound,
wounded with pressure ulcers

1. Admission DME Categories