Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.12
Durable Medical Equipment, Prosthetics, Orthotics and
10.12 – Durable Medical Equipment, Prosthetics, Orthotics and
Supplies (DMEPOS)
(Rev. 120, Issued: 01-16-15, Effective: 01-01-15, Implementation: 01-01-15)
MA plans are required to “provide coverage of, by furnishing, arranging for, or making
payment for, all services that are covered by Medicare Part A and Part B” (see 42 CFR
422.101(a)), which includes coverage of durable medical equipment, prosthetics and
supplies. The MAO is responsible for maintaining continuity of care for its enrollee by
ensuring uninterrupted access to the medically necessary covered DME item, including
when the item needs to be repaired or replaced. If necessary, the MAO must purchase or
rent a replacement item for the beneficiary to use.