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Durable Medical Equipment:
Determination of Benefits for Durable Medical Equipment will be based on the following.
is appropriate for use in the patient's home.
the most appropriate supply or level of service that can safely be provided to the member.
Benefits for rental or purchase of Durable Medical Equipment.
Limitations in connection with Durable Medical Equipment.
Certain Durable Medical Equipment will require periodic re-certification during use to evaluate significant therapeutic improvement in the Subscriber's condition in order to determine the continued medical necessity for the equipment.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY6/1992: Issued
9/1999: Revised based on Master Contract
4/11/2001: "Personal Comfort, Personal Hygiene, Convenience Items" policy which was issued 7/1993 has been combined with "DME" policy.
6/25/2001: Hyperlink to "DME Manual Revisions" added, which provides Claims Processing Guidelines
2/27/2002: Managed Care Requirements deleted; "The rental or purchase of appropriate DME will also include any set up or instruction charges" added
3/6/2002: Claims processing information deleted
9/11/2002: # 6 DME Exclusions revised
SOURCE(S)Durable Medical Equipment Manual, Page E00001 - "Personal Comfort, Personal Hygiene, Convenience Items" sources
Master Contract (12/1991) - "Personal Comfort, Personal Hygiene, Convenience Items" sources
Uniform Medical Policy Manual (11/1989) - "Personal Comfort, Personal Hygiene, Convenience Items" sources
Master Contract 1992
Master Contract, 1999
Primary Care Health Plan Contract,1999