Durable Medical Equipment
Covered by TRICARE? | Limits |
---|
Yes
| Not all equipment is covered. There are limits. Must be prescribed
|
TRICARE covers durable medical equipment (DME) when prescribed by a physician. DME is defined as an item that:
- Can withstand repeated use;
- Primarily and customarily serves a medical purpose; and
- Generally is not useful to an individual in the absence of an injury or illness.
TRICARE covers DME that:
- Improves, restores, or maintains the function of a malformed, diseased, or injured body part, or can otherwise minimize or prevent the deterioration of the patient's function or condition
- Maximizes the patient's function consistent with the patient's physiological or medical needs
- Provides the medically appropriate level of performance and quality for the medical condition present
- Is not otherwise excluded by the regulation and policy
DME may be rented or purchased. However, your regional contractor will decide if a DME should be rented or purchased based on whether it is more economical and appropriate.
TRICARE also covers:
- Medically necessary customization or attachments to the DME to accommodate your medical disability, when your physician has prescribed the equipment as medically necessary and appropriate.
- Medically necessary covered accessories and attachments to a DME necessary to make the DME “serviceable” for a particular disability. For example, a car lift that is an accessory to a wheelchair.
- Repairs to equipment that you own when needed to make the item serviceable.
- Replacement of DME that you own when:
- There's a change in your physical condition,
- There's accidental damage to the DME, or
- The DME is inoperative and can't be repaired, or
- The U.S. Food and Drug Administration have declared the DME adulterated.
- Duplicate items (those that serve the same purpose, but may not be an exact duplicate, such as a portable oxygen concentrator as a backup for a stationary oxygen generator) that are essential to provide a fail-safe, in-home, life-support system.
TRICARE may cover:
- Electric-powered, cart-type vehicles as an alternate to an electric wheelchair.
- Benefits will not be extended for the use of both an electric-powered, cart-type vehicle.
TRICARE doesn't cover:
- DME for a beneficiary who is a patient in a type of facility that ordinarily provides the same type of DME item to its patients at no additional charge in the usual course of providing its services is excluded.
- DME available to the beneficiary from a military hospital or clinic
- DME with deluxe, luxury, or immaterial features, which increase the cost of the item to the government relative to similar item without those features.
- Routine periodic servicing, such as testing, cleaning, regulating, and checking which the manufacturer doesn't require be performed by an authorized technician.
- Duplicate items of otherwise allowable DME to be used solely as a back-up to currently owned or rented equipment.
- Expendable items such as incontinent pads, diapers, ace bandages etc.
- Non-medical equipment (e.g., humidifier, electric air cleaners, exercycle, safety grab bars etc.).