Previous

General Considerations for Assistive Technology/DME Reimbursement
by the Maine Care Program

March 2005

What are the general requirements for Durable Medical Equipment (DME)?

In order for a piece of equipment or medical/surgical supply to be considered for reimbursement as DME, the following criteria must be met.

1. Comply with the definitions stated below;
2. Be considered reasonable and necessary for the treatment of a member’s physical illness or injury or to improve an altered body function, must be prescribed by a physician or primary care provider (PCP); and must meet the criteria stated below;
3. Be provided to a member who is not hospitalized, unless necessary for transition to home (equipment and supplies must have authorization to provision);
4. Have scientifically valid clinical evidence of their efficacy and not be considered investigational or experimental by the Department;
5. Be approved as defined by the Food and Drug Administration, and
6. Be provided by a Maine Care authorized provider of medical supplies and durable medical equipment who has a location where members can procure repairs and servicing of items with warranties and guarantees, or meet one of the exceptions outlined in Chapter II, Section 60.01 of the Maine Care Manual.

Next