Durable Medical Equipment (DME) Clinical Guidelines for Medical Necessity

Covers Medicare DME items that meet medical necessity per the Medicare Benefit Policy Manual, applicable NCDs/LCDs, eviCore DME guidelines (effective 1/1/2021) and MCG; excludes non‑Medicare items and any DME not meeting those referenced criteria, and the document itself does not specify item‑level coverage, frequency, or age limits. Key requirements: prior authorization via eviCore with submission of clinical documentation demonstrating medical necessity as defined by the cited source documents; items not meeting those criteria may be denied.

"DME services/items covered per eviCore DME guidelines - effective 1/1/2021."

Sign up to see full coverage criteria, indications, and limitations.