Custom Fit Durable Medical Equipment (DME) - DME.CU.102.A

Custom-fit DME is covered only when standard DME coverage criteria are met and the need is for a permanent or long-standing condition in which the patient either medically requires a custom device, cannot be fitted with a standard pre-made device, or has failed a trial of a standard device; temporary conditions or cases where a standard device fits are excluded. Coverage requires documentation of basic DME criteria and permanence, clinical evidence of one of the three indications, records showing custom fitting beyond minimal self-adjustment performed by a certified orthotist or specially trained individual, and standard DME MAC documentation per Medicare Local Coverage Article A55426.

"Custom fitted DME is indicated when basic coverage criteria have been met, the condition requiring the device is anticipated to be permanent or of long-standing duration, and any of the following:"