Durable Medical Equipment

TRICARE covers durable medical equipment (DME) when prescribed by a physician. DME is defined equally an item that:

  • Can withstand repeated utilise;
  • Primarily and customarily serves a medical purpose; and
  • Generally is not useful to an private in the absence of an injury or affliction.

TRICARE covers DME that:

  • Improves, restores, or maintains the function of a malformed, diseased, or injured torso function, or tin can otherwise minimize or prevent the deterioration of the patient'south function or status
  • 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 information technology is more economical and appropriate.

TRICARE as well covers:

  • Medically necessaryTo be medically necessary means it is appropriate, reasonable, and acceptable for your condition. customization or attachments to the DME to accommodate your medical disability, when your doc has prescribed the equipment equally medically necessary and appropriate.
  • Medically necessary covered accessories and attachments to a DME necessary to make the DME "serviceable" for a particular inability. For instance, a car lift that is an accessory to a wheelchair.
  • Repairs to equipment that you ain when needed to make the item serviceable.
  • Replacement of DME that yous own when:
    • There'southward a change in your physical condition,
    • There'southward accidental damage to the DME, or
    • The DME is inoperative and can't be repaired, or
    • The U.Due south. Food and Drug Administration have declared the DME adulterated.
  • Indistinguishable items (those that serve the same purpose, but may not be an verbal duplicate, such as a portable oxygen concentrator equally a fill-in for a stationary oxygen generator) that are essential to provide a fail-rubber, in-home, life-support system.

TRICARE may cover:

  • Electric-powered, cart-type vehicles every bit 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 aforementioned type of DME detail to its patients at no boosted 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 like detail 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 commanded DME to be used solely as a dorsum-upwards to currently owned or rented equipment.
  • Expendable items such as incontinent pads, diapers, ace bandages etc.
  • Not-medical equipment (e.thou., humidifier, electrical air cleaners, exercycle, prophylactic grab bars etc.).

FDA Recall of Sure Slumber and Respiratory Devices

Certain sleep and respiratory devices, including CPAP, BiPAP, and some ventilators are included in the recall.

Disclaimer:

This listing of covered services is not all inclusive. TRICARE covers services that are medically necessary and considered proven. At that place are special rules or limits on certain services, and some services are excluded.

Last Updated three/20/2022