Custom Fit DME - DME.CU.102.A

Custom-fit DME, prosthetics, and orthotics are covered only when basic coverage criteria are met and documentation shows one of four reasons: deformity or body habitus that precludes standard fitting, a stabilization need not met by standard fitting, or a failed trial of a standard-fit device; absent these, custom-fit items are not indicated. Required documentation includes evidence that basic coverage criteria are met and the specific reason for custom fitting, and a standard-fit trial should be attempted unless clearly precluded.

"Custom-fit equipment, prosthetics and orthotics may be indicated when basic coverage criteria have been met and there is documentation of one of the following:"

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