Durable Medical Equipment
|Covered by TRICARE?||Limits|
||Not all equipment is covered. There are limits. Must be prescribed
TRICARE covers durable medical equipment (DME) when prescribed by a physician. DME is defined as an item that:
- Can withstand repeated use;
- Primarily and customarily serves a medical purpose; and
- Generally is not useful to an individual in the absence of an injury or illness.
TRICARE covers DME that:
- Improves, restores, or maintains the function of a malformed, diseased, or injured body part, or can otherwise minimize or prevent the deterioration of the patient's function or condition
- Maximizes the patient's function consistent with the patient's physiological or medical needs
- Provides the medically appropriate level of performance and quality for the medical condition present
- Is not otherwise excluded by the regulation and policy
DME may be rented or purchased. However, your regional contractor will decide if a DME should be rented or purchased based on whether it is more economical and appropriate.
TRICARE also covers:
- Medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. customization or attachments to the DME to accommodate your medical disability, when your physician has prescribed the equipment as medically necessary and appropriate.
- Medically necessary covered accessories and attachments to a DME necessary to make the DME “serviceable” for a particular disability. For example, a car lift that is an accessory to a wheelchair.
- Repairs to equipment that you own when needed to make the item serviceable.
- Replacement of DME that you own when:
- There's a change in your physical condition,
- There's accidental damage to the DME, or
- The DME is inoperative and can't be repaired, or
- The U.S. Food and Drug Administration have declared the DME adulterated.
- Duplicate items (those that serve the same purpose, but may not be an exact duplicate, such as a portable oxygen concentrator as a backup for a stationary oxygen generator) that are essential to provide a fail-safe, in-home, life-support system.
TRICARE may cover:
- Electric-powered, cart-type vehicles as an alternate to an electric wheelchair.
- Benefits will not be extended for the use of both an electric-powered, cart-type vehicle.
TRICARE doesn't cover:
- DME for a beneficiary who is a patient in a type of facility that ordinarily provides the same type of DME item to its patients at no additional charge in the usual course of providing its services is excluded.
- DME available to the beneficiary from a military hospital or clinic
- DME with deluxe, luxury, or immaterial features, which increase the cost of the item to the government relative to similar item without those features.
- Routine periodic servicing, such as testing, cleaning, regulating, and checking which the manufacturer doesn't require be performed by an authorized technician.
- Duplicate items of otherwise allowable DME to be used solely as a back-up to currently owned or rented equipment.
- Expendable items such as incontinent pads, diapers, ace bandages etc.
- Non-medical equipment (e.g., humidifier, electric air cleaners, exercycle, safety grab bars etc.).
This list of covered services is not all inclusive. TRICARE covers services that are medically necessary and considered proven. There are special rules or limits on certain services, and some services are excluded.