Durable Medical Equipment Table of Contents

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Durable Medical Equipment Section

Policy Name	Policy ID Number	Date Modified
Bone Growth Stimulators (Osteogenic Stimulation)	M-DME83.12	06/01/2023
Commode Chairs With Seat Lift Mechanism	M-DME06	09/01/2023
Definitive Lower Limb Prostheses	M-DME18	04/01/2024
Durable Medical Equipment, Prosthetic and Orthotic Replacements, Duplicates, Repairs, and Upgrades to Existing Equipment	M-DME75	10/01/2023
Electrical Stimulation and Electromagnetic Therapy Devices	M-DME83	04/07/2024
General Medical Necessity Guidance for Durable Medical Equipment, Prosthetic, Orthotics and Supplies (DMEPOS)	M-DME88	01/01/2024
Gradient Compression Garments (Excluding Burn Garments)	M-DME92	02/01/2024
Multi-Positional Patient Transfer System	M-DME23	09/01/2023
Myoelectric Prosthetic and Orthotic Components for the Upper Limb	M-DME80	08/01/2023
Negative Pressure Wound Therapy in the Outpatient Setting	M-DME42	02/01/2024
Noninvasive Ventilators in the Home Setting	M-DME87	04/01/2024
Pneumatic Compression Devices	M-DME78	09/01/2023
Power Wheelchairs - Group 2 and Group 3	M-DME37	04/01/2024
Powered Exoskeleton for Ambulation and Rehabilitation	M-DME89	04/01/2024
Powered and Microprocessor-Controlled Knee and Ankle-Foot Prostheses and Microprocessor-Controlled Knee-Ankle-Foot Orthoses	M-DME81	01/01/2024
Tumor Treatment Field Therapy (TTFT)	M-DME85	04/01/2024
Upper Extremity Rehabilitation System with Brain-Computer Interface	M-DME94	04/01/2024


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