DME reimbursement alerts

CMS is updating the annual clotting factor furnishing fee for 2027, effective January 4, 2027. Billing teams must update their fee schedules to reflect the new furnishing fee amounts for clotting fact

This transmittal updates Medicare Benefit Policy Manual Chapter 15, Section 110.8 regarding Durable Medical Equipment (DME) policy. Billing teams should review the updated DME coverage criteria and do

This proposed LCD from all four DME MACs addresses coverage criteria for external breast prostheses, which are typically covered following mastectomy procedures. As a draft LCD, stakeholders have unti

This proposed LCD from all four DME MACs addresses coverage criteria for oxygen and oxygen equipment, which is a high-volume DME benefit with strict medical necessity documentation requirements. As a

This one-time notification (CR 14538) implements VMS Application Programming Interfaces (APIs) to support Durable Medical Equipment processes, effective October 5, 2026. Billing teams should prepare f

This active Final LCD (L33823) governs coverage of cervical traction devices under DME MAC jurisdiction, effective January 1, 2020. It establishes medical necessity criteria, coverage indications, and

This active LCD (L33825) governs coverage criteria for Infrared Heating Pad Systems under DME MAC jurisdiction, effective January 2020. It establishes billing and coverage requirements for these devic

This active Final LCD (L33690) governs coverage criteria for Automatic External Defibrillators (AEDs) under the DME MAC contractors across all regions, effective January 1, 2020. It establishes billin

This active Final LCD (L33733) from all four DME MACs establishes coverage criteria for canes and crutches under the Medicare DME benefit, effective January 1, 2020. It defines medical necessity requi

This active Final LCD (L33735) governs coverage criteria for Cold Therapy devices under the DME MAC contractors, effective January 1, 2020. It establishes medical necessity requirements and limitation

This active LCD L33736 governs Medicare coverage criteria for commodes under DME MAC jurisdiction, effective January 2020. It establishes medical necessity requirements and documentation standards for

This active Final LCD (L34824) governs Medicare coverage criteria for Vacuum Erection Devices (VED) under all four DME MACs, effective January 1, 2020. It establishes the conditions under which Medica

This active Final LCD (L33795) governs Medicare coverage criteria for mechanical in-exsufflation devices (cough assist devices) under DME MAC jurisdiction, effective January 1, 2020. It establishes do

This active Final LCD (L33820) governs Medicare coverage criteria for hospital beds and accessories under the DME MAC jurisdiction, effective January 1, 2020. It establishes medical necessity requirem

This active Final LCD L33737 covers Eye Prostheses under all four DME MACs, establishing coverage criteria, documentation requirements, and billing guidelines for ocular prosthetic devices. Providers

This active Final LCD L33738 covers Facial Prostheses under DME MAC jurisdiction, establishing coverage criteria for Medicare billing of facial prosthetic devices. Providers billing for facial prosthe

This active Final LCD (L33641) governs coverage criteria for orthopedic footwear under DME MAC jurisdiction, effective January 1, 2020. It establishes billing and documentation requirements for therap

This active Final LCD (L33799) governs Medicare coverage criteria for patient lifts under the DME MAC jurisdictions, effective January 2020. It establishes medical necessity requirements that provider

This active LCD L33784 governs Medicare coverage criteria for heating pads and heat lamps under DME MAC jurisdiction, effective January 1, 2020. It establishes billing and coverage requirements for th

This active LCD (L33786) governs coverage criteria for Intrapulmonary Percussive Ventilation (IPV) systems under DME MAC contractors, effective January 2020. It establishes billing and medical necessi

This active final LCD (L33791) governs Medicare coverage criteria for walkers under the DME MAC jurisdictions, effective January 1, 2020. It establishes medical necessity requirements and documentatio

This active Final LCD (L33788) governs coverage criteria for manual wheelchair bases under DME MAC jurisdictions A, B, C, and D, effective January 1, 2020. It establishes medical necessity requirement

This final LCD (L34823) from DME MAC contractors covers Tumor Treatment Field Therapy (TTFT), a device-based treatment for certain cancers, establishing coverage criteria and billing requirements effe

This active Final LCD (L34821) governs coverage criteria for Transcutaneous Electrical Joint Stimulation Devices (TEJSD) under DME MAC jurisdictions A, B, C, and D, effective January 1, 2020. It estab

This active Final LCD (L33790) governs coverage criteria for Thoracic-Lumbar-Sacral Orthoses (TLSO) and Lumbar-Sacral Orthoses (LSO) under DME MAC jurisdiction, effective January 1, 2020. It establish

This active LCD (L33369) establishes coverage criteria for therapeutic shoes and inserts for Medicare beneficiaries with diabetes, administered by all four DME MACs nationwide. Providers must document

This active LCD L33793 covers refractive lenses under DME MAC jurisdiction, establishing coverage criteria for corrective lenses billed through durable medical equipment contractors. Providers should

This active LCD (L33692) establishes coverage criteria for Group 3 pressure reducing support surfaces under DME MAC jurisdiction, effective May 2021. It defines medical necessity requirements for the

This active Final LCD (L33830) governs coverage criteria for Group 1 Pressure Reducing Support Surfaces under DME MAC jurisdiction, effective May 2021. It establishes medical necessity requirements fo

This active Final LCD (L33642) governs coverage criteria for Group 2 Pressure Reducing Support Surfaces under DME MAC jurisdictions, effective May 2021. It establishes the medical necessity requiremen

This active Final LCD (L33611) governs coverage of oral appliances for obstructive sleep apnea under all four DME MACs, establishing documentation and medical necessity requirements for billing. Provi

This active LCD establishes coverage criteria for High Frequency Chest Wall Oscillation (HFCWO) devices under DME MAC jurisdiction, effective October 2022. It defines qualifying diagnoses and document

This active Final LCD (L33797) governs coverage criteria for oxygen and oxygen equipment under the DME MAC contractors, effective April 1, 2023. It establishes medical necessity requirements that prov

This active final LCD (L33801) governs coverage criteria for seat lift mechanisms under the DME MAC contractors, effective July 2023. It establishes medical necessity requirements for power seat lift

This active Final LCD (L38955) governs coverage criteria for Enteral Nutrition under DME MAC jurisdiction, effective January 1, 2024. It establishes the conditions under which enteral nutrition produc

This active LCD governs coverage of Positive Airway Pressure (PAP) devices for treating Obstructive Sleep Apnea under all four DME MACs, effective January 1, 2024. It establishes coverage criteria, do

This active Final LCD (L33821) governs coverage of Negative Pressure Wound Therapy (NPWT) pumps under DME MAC jurisdictions A, B, C, and D, effective January 1, 2024. It establishes the medical necess

This active Final LCD (L33796) governs coverage criteria for osteogenesis stimulators under DME MAC jurisdiction, effective January 1, 2024. It defines when bone growth stimulators (electrical, ultras

This active Final LCD (L38953) governs coverage criteria for Parenteral Nutrition under DME MAC jurisdiction, effective January 1, 2024. It establishes billing and coverage requirements for parenteral

This active Final LCD (L33612) governs coverage criteria for suction pumps under the DME MAC benefit, effective January 1, 2024. It establishes medical necessity requirements for Medicare billing of s

This active final LCD (L33802) governs coverage criteria for Transcutaneous Electrical Nerve Stimulators (TENS) under DME MAC jurisdictions A, B, C, and D, effective January 1, 2024. It establishes me

This active Final LCD (L33828) governs Medicare coverage and billing requirements for ostomy supplies under the DME MAC contractors (Jurisdictions A, B, C, and D), effective January 1, 2024. It establ

This active Final LCD (L33831) governs coverage criteria for surgical dressings under DME MAC jurisdictions A, B, C, and D, effective January 1, 2024. It establishes documentation and medical necessit

This final LCD (L39591) establishes coverage criteria for External Upper Limb Tremor Stimulator Therapy under DME MAC jurisdictions, effective April 7, 2024. It defines when non-invasive wearable neur

This active Final LCD (L33822) governs coverage criteria for glucose monitors under the DME MAC contractors, effective October 1, 2024. It establishes billing and coverage requirements for glucose mon

This active Final LCD L33317 governs Medicare coverage criteria for external breast prostheses under DME MAC jurisdictions (A, B, C, D), effective April 1, 2025. It establishes billing and documentati

This final LCD L33312 from all four DME MACs establishes coverage criteria for wheelchair seating, effective October 1, 2025. It defines medical necessity requirements for custom and prefabricated whe

This active Final LCD (L33800) governs coverage criteria for Respiratory Assist Devices under DME MAC jurisdiction, effective June 2025 with a recent October 2025 update. It establishes medical necess

This active Final LCD (L33739) governs coverage criteria for Speech Generating Devices (SGDs) under DME MAC jurisdictions A, B, C, and D, effective October 1, 2024 and updated October 2025. It establi

This active Final LCD L33789 governs coverage criteria for Power Mobility Devices (PMDs), including power wheelchairs and scooters, under the DME MAC jurisdiction effective October 1, 2025. It establi