Durable Medical Equipment (DME) General Criteria - DME.AD.100.A

DME is covered only when medically necessary with appropriate documentation; duplicate or same/similar devices and accessories are excluded unless there is a change in medical condition, a new diagnosis, or established replacement criteria, and accessories are not covered if the base DME is not medically necessary. Key requirements include clinically relevant information, a pertinent clinical evaluation or meaningful technological contact (telehealth/phone/email), a relevant history and physical and prior treatment records, and clear documentation per DME MAC standards to justify the request or replacement.

"Information provided has clinical relevance to the request"

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