NCD 280.1: Durable Medical Equipment Reference List
Medicare covers DME meeting four criteria: durable (3+ years), used for medical purpose, not useful in absence of illness, appropriate for home use. NCD 280.1 contains the comprehensive reference list.
What's covered
- Hospital beds, wheelchairs, walkers, canes
- Oxygen equipment, CPAP, BiPAP, nebulizers
- Diabetic supplies, blood glucose monitors
- Catheters, ostomy supplies
- Most prosthetics and orthotics
Coverage criteria
- Durable (≥3 years expected useful life)
- Used to serve medical purpose
- Useless in absence of illness or injury
- Appropriate for home use
Exclusions
- Disposable items lasting <3 years (with some exceptions)
- Comfort/convenience items
- Items primarily for environmental modifications
Common denial patterns
- DME deemed convenience item
- Home use not documented
- Equipment supplier not enrolled with Medicare
- Face-to-face encounter requirement not met (within 6 months for many DME)
Appeal citation
NCD 280.1 (DME Reference List). Cite face-to-face encounter, medical necessity, home appropriateness, durability.
Frequently asked questions
What does Medicare NCD 280.1 cover?
Medicare covers DME meeting four criteria: durable (3+ years), used for medical purpose, not useful in absence of illness, appropriate for home use. NCD 280.1 contains the comprehensive reference list.
What are the coverage criteria?
Durable (≥3 years expected useful life); Used to serve medical purpose; Useless in absence of illness or injury; Appropriate for home use.
What is excluded?
Disposable items lasting <3 years (with some exceptions); Comfort/convenience items; Items primarily for environmental modifications.
How do I cite this NCD in an appeal?
NCD 280.1 (DME Reference List). Cite face-to-face encounter, medical necessity, home appropriateness, durability.
Sources
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