Durable Medical Equipment (DME) plays a vital role in improving the quality of life for individuals with various medical conditions. From assisting mobility to supporting long-term health management, these essential tools ensure comfort, safety, and independence.
In this guide, we’ll detail what exactly DME is, its types, the regulations surrounding it, and how it applies to residents of Ohio.
What is Considered Durable Medical Equipment?
Durable Medical Equipment refers to medical tools designed to serve a therapeutic purpose for individuals with medical needs.
It has both a broad medical and specific legal definition.
Durable medical equipment is equipment which can withstand repeated use... and is primarily and customarily used to serve a medical purpose... and generally is not useful to a person in the absence of an illness or injury...and is appropriate for use in the home.
Medicare defines DME as equipment which meets the following criteria:
Durable (can withstand repeated use)
Used for a medical reason
Typically only useful to someone who is sick or injured
Used in your home
Expected to last at least 3 years
Common Types of Durable Medical Equipment
DME covers a broad spectrum of devices tailored to meet diverse needs. Below are common categories of DME:
Category | Description | Examples |
Mobility Aids | These devices assist individuals with impaired movement capabilities. | Walkers, Wheelchairs, Canes, Crutches |
Home Care Beds and Accessories | Designed for individuals with limited mobility. | Adjustable hospital beds, Bed rails, Pressure-relief mattresses |
Respiratory Equipment | Essential for individuals with respiratory disorders. | Oxygen concentrators, nebulizers, Continuous Positive Airway Pressure (CPAP) machines |
Monitoring Devices | Devices which are critical for managing chronic conditions such as diabetes. | Glucose monitors |
Bathroom Safety Devices | Providing safety and independence in personal care. | Shower chairs, commodes, grab bars |
Medicaid Coverage in Ohio
Ohio residents can access Durable Medical Equipment (DME) through Medicaid, Medicare, or private insurance, with each program outlining specific criteria for coverage. The Ohio Department of Medicaid (ODM) offers extensive coverage for medically necessary DME. To qualify, equipment must meet accepted medical standards, be prescribed by a licensed healthcare provider, and be suitable for home use.
Additionally, certain high-cost items may require prior authorization or a Certificate of Medical Necessity, ensuring compliance with Ohio Medicaid guidelines.
Durable Medical Equipment Medicare
Medicare Part B also provides coverage for a wide range of DME items intended for home use. To qualify for Medicare coverage, equipment must be deemed medically necessary and prescribed by a Medicare-approved doctor. Commonly covered items include wheelchairs, walkers, and oxygen systems.
Patients are typically responsible for paying 20% of the Medicare-approved amount after meeting the Part B deductible, as outlined on Medicare.gov.
Regulations for Durable Medical Equipment in Ohio
In Ohio, strict regulations govern the provision and use of DME:
Provider Requirements
DME providers must:
Be enrolled with ODM or Medicare.
Maintain necessary certifications and licenses.
Comply with billing and documentation standards.
Medical Necessity
Documentation must clearly establish the medical need for all DME provided. Providers often require detailed prescriptions and certificates to ensure compliance.
Prior Authorization
Some DME items require prior authorization to confirm medical necessity. Examples include motorized wheelchairs and oxygen concentrators.
Where to find Durable Medical Equipment in Ohio
The Medicare website features an interactive map where patients can search by Zip Code and Equipment type.
Durable Medical Equipment is a cornerstone of modern healthcare, enabling individuals to manage their medical conditions effectively.
By understanding what DME is and its coverage options, Ohio residents can maximize their quality of life.