Durable Medical Equipment (DME) Clinical Guidelines

Coverage: DME items/services are covered only if they meet the Medicare Benefit Policy Manual and applicable NCDs/LCDs criteria, and for individual and commercial plans if they meet McKesson InterQual® criteria; items not deemed "reasonable and necessary" by those sources are excluded. Key requirements: clinical documentation must demonstrate medical necessity per the referenced Medicare/NCD/LCD or InterQual criteria, with device‑level coverage rules, frequency limits, age restrictions, and prior‑treatment requirements governed by those referenced policies (not detailed here).

"Durable Medical Equipment (DME) items/services that meet Medicare medical necessity criteria as defined by the Medicare Benefit Policy Manual, National and Local Coverage Determinations (NCDs/LCDs)..."

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