The numbers that decide your DME bill
Here's what to do, in 4 steps.
Here's the order I'd work this in if I were sitting next to you. The biggest risk on a DME claim is not the item — it's the supplier and the paperwork. Get those right and the rest is plumbing.
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Confirm your supplier is Medicare-enrolled
Before you take possession of any DME, ask the supplier for their Medicare supplier number (PTAN) and verify it. A non-enrolled supplier cannot bill Medicare and may bill you the full retail price. Use Medicare.gov's supplier directory to confirm before you sign anything.
Time: 10 minutes Cost: Free Medicare.gov supplier directory
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Check whether your item needs prior authorization
Certain DME categories — power mobility devices, lower-limb prostheses, certain pressure-reducing support surfaces, and select wheelchair accessories — require Medicare prior authorization before the supplier can deliver. The supplier files the prior-auth request; your job is to make sure they actually file it before they ship.
Time: Same day Cost: Free CMS prior authorization program
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Understand rental versus purchase
Most DME isn't bought outright. Capped-rental items (hospital beds, manual wheelchairs, CPAP, and most others) rent for thirteen months and then transfer to you. Oxygen rents for thirty-six months, after which the supplier still owes you equipment service for up to five years. Know which clock applies before you start.
Time: 20 minutes Cost: Free 42 CFR 414.229 — capped-rental rule
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Get a written supplier statement
Ask the supplier in writing whether they accept Medicare assignment on every monthly rental claim, what your cost share will be, and what happens at the end of the rental period. Suppliers are required by 42 CFR 414.229(g)(3) to disclose their assignment intentions. If they won't put it in writing, walk away.
Time: 15 minutes Cost: Free Medicare DME coverage page
Dr. Ed explains Medicare DME
Video coming soon
I'm recording a walkthrough on the supplier-enrollment trap, the capped-rental clock, and the prior-authorization list. Until it's posted, the action plan below covers the same ground.
Which of these sounds more like you?
DME questions break into a handful of patterns. Find the one that sounds most like you and start there.
I need a CPAP and want to know what it'll costSleep apnea, BiPAP, or PAP equipment
CPAP and BiPAP machines are capped-rental items. Medicare pays the supplier monthly for thirteen months, you pay your twenty percent each month, and on the first day after the thirteenth month the supplier transfers ownership to you. The supplies (mask, tubing, filters) are billed separately as routinely-purchased items.
Medicare requires a face-to-face evaluation, a sleep study showing qualifying apnea, and a ninety-day compliance check before continuing rental. If you don't use the machine enough during that ninety-day window, Medicare can stop paying.
I'm on home oxygen and want to know how the rental worksStationary or portable oxygen
Oxygen equipment runs on a thirty-six-month rental clock under 42 CFR 414.226(a)(1). After the thirty-sixth month, you don't own the equipment — the supplier still does — but they're required to keep furnishing it for the remainder of the equipment's reasonable useful lifetime, which is at least five years from when it was first delivered.
During those last twenty-four months, Medicare pays the supplier a maintenance-and-servicing fee twice a year. Oxygen contents (the gas itself) are billed separately and continue throughout your medical need.
I need a power wheelchair or scooterPower mobility devices
Power mobility devices — power wheelchairs and scooters — require Medicare prior authorization before the supplier can deliver. Your doctor must conduct a face-to-face exam documenting why a cane, walker, or manual wheelchair won't meet your needs in the home. The supplier files the prior-auth request; CMS responds within ten business days.
If the request is denied, the supplier should not deliver. If they deliver anyway and the claim is denied, you may be billed for the full amount unless the supplier accepted assignment in writing.
My DME claim was denied and I don't know whyCoverage denials and appeals
DME denials usually come down to one of four things: the supplier wasn't Medicare-enrolled, the doctor's order was missing or incomplete, the item wasn't on the prior-auth list (or was, and wasn't pre-authorized), or the equipment was used outside the home in a way Medicare considers ineligible.
You have one hundred twenty days from the date of the Medicare Summary Notice to file the first level of appeal (redetermination). Don't miss that window. SHIP at 1-877-839-2675 can help you understand the appeal architecture before you file.
I want a continuous glucose monitor (CGM)Diabetes-related DME
Continuous glucose monitors are covered as DME when your doctor documents that you have diabetes treated with insulin or have a history of problematic hypoglycemia. CMS expanded CGM coverage in recent years, so the criteria are looser than they used to be — but the documentation requirements still matter.
Like most DME, CGMs flow through a Medicare-enrolled DME supplier with a written order. Test strips and sensors are billed as separate supply items.
I want grab bars or shower safety equipmentItems Medicare doesn't cover as DME
Grab bars, shower chairs, raised toilet seats, and most bathroom safety equipment are not covered as Medicare DME. Medicare's DME definition requires the item to serve a medical purpose, withstand repeated use, and be unsuitable for someone who isn't sick or injured — grab bars don't meet that last test because anyone can use them.
Some Medicare Advantage plans include supplemental benefits that may cover bathroom safety items; benefits and availability vary by plan and service area. SHIP at 1-877-839-2675 can help you compare options.
I'm helping a parent get equipment they needAdult child or caregiver
If you're sorting out DME for a parent, spouse, or other family member, you'll need to coordinate three people: the prescribing doctor, the supplier, and the beneficiary. The doctor writes the order. The supplier verifies Medicare enrollment, files prior auth if needed, and bills Medicare. The beneficiary signs the supplier's paperwork and pays the twenty-percent share.
If the beneficiary can't manage the paperwork themselves, you'll likely need a power of attorney or representative-payee arrangement on file with Medicare. SHIP at 1-877-839-2675 can walk you through what authorization you need.
None of these match — I just want to talk to someoneWhen you need a person, not a page
If your DME question doesn't fit any of the patterns above, the right next step is talking to a person. Two free options: SHIP at 1-877-839-2675 for unbiased Medicare counseling (every state runs one), or a Chapter licensed advisor who can walk you through how Original Medicare versus a Medicare Advantage plan would handle your specific equipment.
Don't call the DME supplier first. They're salespeople. Get the framing from a neutral source, then approach the supplier knowing what you're looking for.
Everything people ask me about DME
What counts as durable medical equipment under Medicare?
DME is equipment that's durable (can withstand repeated use), used for a medical reason, not useful to someone who isn't sick or injured, used in your home, and has an expected lifetime of at least three years. Examples: wheelchairs, walkers, hospital beds, oxygen equipment, CPAP machines, glucose monitors, nebulizers, and infusion pumps.
How much does Medicare pay for DME?
After you meet your annual Part B deductible, Medicare pays 80% of the Medicare-approved amount, and you pay the remaining 20%. This split is set by 42 CFR 414.210(a). The Medicare-approved amount may be the supplier's actual charge or the published fee schedule amount, whichever is lower.
Why does my supplier rent the equipment instead of selling it?
Most DME falls into a category called "capped rental" under 42 CFR 414.229. Medicare pays the supplier a monthly rental fee for up to 13 months, and on the first day after the 13th month the supplier transfers title to you. Oxygen equipment is a separate exception with a 36-month rental cap and a five-year supplier obligation.
Do I need prior authorization for my DME?
Only certain items require prior authorization — primarily power mobility devices, lower-limb prostheses, certain pressure-reducing support surfaces, and select wheelchair accessories. The CMS prior-auth list expands periodically. Your supplier should know whether your specific item is on the list and should file the prior-auth request before delivery.
What's the Competitive Bidding Program and does it affect me?
The DMEPOS Competitive Bidding Program (CBP) is a CMS payment system in which Medicare contracts with selected suppliers in designated bidding areas to lower prices on certain DME categories. The Round 2021 contracts were paused for most categories; off-the-shelf back and knee braces remain under CBP. If you live in a bidding area for an active category, you must use a contracted supplier.
Will Medicare pay for grab bars, raised toilet seats, or shower chairs?
No — Original Medicare does not classify bathroom safety equipment as DME because it's also useful to people who aren't sick or injured. Some Medicare Advantage plans include supplemental benefits that may cover bathroom safety items; benefits and availability vary by plan and service area. State Medicaid waiver programs may also cover home modifications.
How does Medicare cover CPAP machines?
CPAP machines are capped-rental DME. Medicare requires a face-to-face evaluation, a sleep study confirming obstructive sleep apnea, and a 90-day compliance check during the rental. If you don't use the machine at least 4 hours per night on 70% of nights during the compliance period, Medicare can stop paying. After 13 months of rental payments, the machine transfers to you.
What happens at the end of the 36-month oxygen rental?
Under 42 CFR 414.226(h), the supplier who provided your oxygen equipment for the 36th month must continue furnishing it during your remaining medical need, through the end of the equipment's reasonable useful lifetime, which is at least 5 years from the original delivery date. Medicare pays the supplier a maintenance-and-servicing fee twice a year during that final period. You don't own the equipment.
Can I use any DME supplier I want?
Only Medicare-enrolled suppliers can bill Medicare. If you live in a Competitive Bidding Program area for an active category, you must use a CBP-contracted supplier for that category. Use the Medicare.gov supplier directory to confirm before signing anything. Non-enrolled suppliers may bill you the full retail price with no Medicare discount.
My DME claim was denied. What do I do?
You have 120 days from the date on the Medicare Summary Notice to file a redetermination, which is the first level of Medicare appeal. There are five appeal levels in total. Common reasons for denial: supplier wasn't enrolled, prior auth wasn't filed, doctor's order was missing, or the item was used outside the home. SHIP at 1-877-839-2675 offers free counseling on appeals.
Programs that pair with Part B for equipment costs
Part B's twenty-percent share on DME adds up fast — especially on long rentals like CPAP, oxygen, or power wheelchairs. If your income is modest, one of these programs may help cover that share or the equipment itself.
Medicare Savings Programs (QMB / SLMB / QI)
If your income is below program limits, you may qualify for a Medicare Savings Program that pays your Part B premium and, in the case of QMB, your DME twenty-percent coinsurance too. Eligibility runs through your state Medicaid office.
Full Medicaid (dual-eligible)
If you qualify for full Medicaid in addition to Medicare, Medicaid may cover your DME coinsurance and may also cover items Original Medicare doesn't (some bathroom safety equipment, home modifications) under your state's Medicaid program. Eligibility varies by state.
Extra Help (Low-Income Subsidy)
Extra Help reduces Part D prescription costs but doesn't directly pay DME bills. If you qualify for Extra Help, you may also qualify for a Medicare Savings Program — the income tests are similar and the application can flag your eligibility for both.
Medigap (Medicare Supplement)
If you have Original Medicare and a Medigap policy, the Medigap plan typically covers your twenty-percent DME coinsurance and may cover the Part B deductible depending on which lettered plan you have. Medigap doesn't apply if you're on a Medicare Advantage plan.
VA Health Care
Veterans enrolled in VA health care may receive DME directly through VA, separate from Medicare. Some veterans use both — VA for primary equipment, Medicare for items VA doesn't supply. The two systems don't coordinate automatically; you choose where to file.
State Medicaid waivers (HCBS)
Home- and Community-Based Services waivers run through your state Medicaid program and may cover home modifications, bathroom safety equipment, and other items Original Medicare doesn't classify as DME. Income and functional eligibility limits apply; waitlists are common.
Help me keep it.
DME rules shift more than people realize — the prior-authorization list expands, the Competitive Bidding Program pauses and restarts, and the items that need a written order keep changing. Drop your email and I'll send the next update when CMS makes a move.
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