Coverage and Payment of Durable Medical Equipment Under

130.4.1 - Coverage and Payment of Durable Medical Equipment Under the RNHCI Home Benefit (Rev. 45, Issued: 02-10-06; Effective: 05-11-06;Implementation: 05-11-06) Medicare covers a defined list of nonmedical DME items for RNHCI home services that are comparable to items used in the inpatient RNHCI setting and could be provided by an HHA. The DME items include canes, crutches, walkers, commodes, a standard wheelchair, hospital beds, bedpans, and urinals. Those RNHCIs offering home services may order these items without a physician order and without compromising the beneficiary election for RNHCI care. The need for each item of DME ordered must be supported by the RNHCI patient’s plan of care for the home setting and the RNHCI nurses’ notes for home services. It must be noted that the benefit is applicable only to what we shall refer to as “nonmedical DME items” and does not include any of the related services provided by RNHCI staff members. The RNHCI shall establish a payment arrangement with one or more DME suppliers to obtain any of the items on the DME list (below) they may require for a beneficiary. The supplier will provide the items and related instructions on use to the beneficiary/family/care giver. The RNHCI will submit claims for these DME items to the RNHCI specialty FI. The RNHCI must stress to suppliers that DME claims are not to be submitted to the DMERC because this will cause the beneficiary’s election for RNHCI care to be revoked. DME Items and HCPCS Codes for use by RNHCI Home Service Units Canes E0100 Cane, includes canes of all materials, adjustable or fixed, with tip E0105 Cane, quad or three prong, includes canes of all materials, adjustable or fixed with tip Crutches E0112 Crutches, underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips E0113 Crutch underarm, wood, adjustable or fixed, pair, with pad, tip and handgrip E0114 Crutches, underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips E0116 Crutch underarm, other than wood, adjustable or fixed, with pad, tip and handgrip Walkers E0130 Walker, rigid (pickup), adjustable or fixed height E0135 Walker, folding (pickup), adjustable or fixed height E0141 Walker, rigid, wheeled, adjustable or fixed height E0143 Walker, folding, wheeled, adjustable or fixed height Commodes E0163 Commode chair, stationary, with fixed arms E0167 Pail or pan for use with commode chair Wheelchairs K0001 Standard wheelchair Hospital Beds & Accessories E0250 Hospital bed, fixed height, with any type side rails, with mattress E0255 Hospital bed, variable height, hi-lo, with any type side rails, with mattress E0260 Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress E0275 Bed pan, standard, metal or plastic E0276 Bed pan, fracture, metal or plastic E0290 Hospital bed, fixed height, without side rails, with mattress E0292 Hospital bed, variable height, hi-lo, without side rails, with mattress E0325 Urinal; male, jug-type, any material E0326 Urinal; female, jug-type, any material Payment to RNHCIs for these specified DME items will be made based on the DME fee schedule. Coinsurance applies to these items. Deductible does not apply to these items.