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In the US a certificate of medical necessity is a document required by Centers for Medicare and Medicaid Services to substantiate in detail the medical necessity of an item of durable medical equipment or a service to a Medicare beneficiary. [1]
It is often referred to as "durable" medical equipment (DME) as it is intended to withstand repeated use by non-professionals or the patient, and is appropriate for use in the home. Medical supplies of an expendable nature, such as bandages, rubber gloves and irrigating kits are not considered by Medicare to be DME.
You can expect to pay 20% of the Medicare-approved amount for DME after you meet your Part B deductible ($257 in 2025). Depending on the type of equipment you’re considering, you may need to ...
Medicare may only cover the cost of the lift-mechanism rather than the entire chair. Before Medicare can be considered for covering the cost, patients will need to have a visit with their physician to discuss the need for this particular equipment. The DME provider will then request a prescription and a certificate of medical necessity (CMN).
The device must also meet specific criteria and be issued under the Durable Medical Equipment (DME) Medicare benefit. Private health plans can have different perks, though.
Durable medical equipment (DME) is a category of medical devices designed to assist individuals with disabilities, injuries, or chronic health conditions. [1] These devices are prescribed by healthcare professionals and intended for repeated use over an extended period.
ACHC was established in 1985 by home care health providers to create an accreditation option which was more focused on the needs of small providers. The process began in Raleigh, North Carolina, with the group incorporated in August 1986. The first accredited organization was awarded certification in January 1987.
The DME scheme was reminiscent of Medicare fraud in South Florida in the 1990s before it spread to other areas of medicine, such as physical therapy, diabetic injections and mental health services.