CG-DME-10 Durable Medical Equipment

Policy addresses: coverage of durable medical equipment (DME). DME is covered when all are met: the item meets the plan’s DME definition; it is not otherwise designated as not medically necessary or investigational by another policy; and medical records/claim documentation show the physician used prudent clinical judgment to order it to prevent, evaluate, diagnose, or treat an illness/injury in accordance with generally accepted, evidence-based standards. Not covered when these criteria are not met, including items for athletics/recreation, environmental controls or home modifications, comfort/convenience or deluxe features, or equipment primarily for outdoor use; some specific DME types may be addressed in separate policies.

"Durable medical equipment is consideredmedically necessarywhenallof the following criteria are met:"

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