Before an item can be considered DME, it must meet all of the following requirements:
It must be able to withstand repeated use.
It must be primarily and customarily used to serve a medical purpose.
It must be generally not useful to a person in the absence of an illness or injury.
It must be appropriate for use in the home.
All E codes fall under the jurisdiction of the DME MAC unless otherwise noted.
Dynamic adjustable knee flexion only device, includes soft interface material
Dynamic adjustable ankle extension and flexion device, includes soft interface material
Static progressive stretch/patient actualized serial stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories
Static progressive stretch/patient actualized serial stretch forearm pronation / supination device, with or without range of motion adjustment, includes all components and accessories
Replacement soft interface material, dynamic adjustable extension/flexion device
Replacement soft interface material/cuffs for bi-directional static progressive stretch device
Dynamic adjustable ankle extension only device, includes soft interface material
Dynamic adjustable ankle flexion only device, includes soft interface material
Dynamic adjustable finger extension and flexion device, includes soft interface material
Dynamic adjustable finger extension only device, includes soft interface material
Continued
Dynamic adjustable finger flexion only device, includes soft interface material
Dynamic adjustable toe extension only device, includes soft interface material
Dynamic adjustable toe flexion only device, includes soft interface material
Dynamic adjustable toe extension and flexion device, includes soft interface material
Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories
Static progressive stretch finger device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories
Dynamic adjustable shoulder flexion / abduction / rotation device, includes soft interface material
Static progressive stretch/patient actualized serial stretch shoulder device, with or without range of motion adjustment, includes all components and accessories
Communication board, non-electronic augmentative or alternative communication device
Virtual reality cognitive behavioral therapy device (cbt), including pre-programmed therapy software
Gastric suction pump, home model, portable or stationary, electric
Suction pump, home model, portable or stationary, electric, any type, for use with external urine and/or fecal management system
Blood glucose monitor with integrated voice synthesizer
Blood glucose monitor with integrated lancing/blood sample
Adjunctive, non-implanted continuous glucose monitor or receiver
Non-adjunctive, non-implanted continuous glucose monitor or receiver
Home blood glucose monitor for use with integrated lancing/blood sample testing cartridge
Pulse generator system for tympanic treatment of inner ear endolymphatic fluid
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches
Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches
Continued
Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches
Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches
Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each
Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each
Wheelchair accessory, crutch and cane holder, each
Wheelchair accessory, cylinder tank carrier, each
Accessory, arm trough, with or without hand support, each
Wheelchair accessory, bearings, any type, replacement only, each
Manual wheelchair accessory, pneumatic propulsion tire, any size, each
Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each
Manual wheelchair accessory, pneumatic caster tire, any size, each
Manual wheelchair accessory, tube for pneumatic caster tire, any size, each
Manual wheelchair accessory, foam filled propulsion tire, any size, each
Manual wheelchair accessory, foam filled caster tire, any size, each
Manual wheelchair accessory, foam propulsion tire, any size, each
Manual wheelchair accessory, foam caster tire, any size, each
Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each
Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each
Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each