A DME supplier is a company that provides durable medical equipment, the devices and tools people use at home to manage a health condition or recover from an injury. These suppliers sell or rent items like wheelchairs, oxygen tanks, CPAP machines, and blood sugar monitors, and they handle everything from delivery and setup to answering your questions about how to use the equipment safely.
To bill Medicare or most insurance plans, a DME supplier must meet strict federal requirements, including independent accreditation and enrollment with the Centers for Medicare & Medicaid Services (CMS). Not every medical supply store qualifies.
What Counts as Durable Medical Equipment
Medicare defines durable medical equipment using four criteria. An item must be able to withstand repeated use (meaning it could be rented to multiple patients over time), serve a primarily medical purpose, generally not be useful to someone without an illness or injury, and be appropriate for use in the patient’s home. A standard household humidifier wouldn’t qualify, for example, but a nebulizer would.
Common categories of covered DME include:
- Mobility aids: canes, crutches, walkers, wheelchairs, and scooters
- Respiratory devices: CPAP machines, oxygen equipment and accessories, nebulizers
- Monitoring tools: blood sugar monitors and related supplies
This list isn’t exhaustive. Hospital beds, patient lifts, and certain braces can also qualify, depending on the medical need and documentation.
What a DME Supplier Is Required to Do
Federal regulations (42 CFR 424.57) spell out what DME suppliers owe their customers. A supplier must deliver Medicare-covered items directly to patients and keep proof of that delivery on file. They’re also required to provide instructions on how to use the equipment safely and effectively, either through their own staff or another qualified party.
Beyond delivery and setup, suppliers must answer your questions and respond to complaints about any item they sold or rented. If you have a billing or coverage question that falls outside their scope, they’re required to point you to the right Medicare contact rather than leaving you to figure it out alone. All of these interactions must be documented.
Accreditation and Enrollment
Before a DME supplier can bill Medicare, it must earn accreditation from a CMS-approved organization. There are currently eight of these organizations, including the Accreditation Commission for Health Care (ACHC), the Joint Commission, and the Healthcare Quality Association on Accreditation (HQAA). The accreditation process evaluates whether the supplier meets quality and safety standards for the equipment it provides.
Accreditation alone isn’t enough. The supplier also needs to formally enroll with CMS, which reviews factors like financial stability and compliance history. This two-layer system is designed to keep unqualified or fraudulent operations out of the Medicare supply chain.
How You Get Equipment Through a DME Supplier
You can’t simply walk into a DME supplier and pick up a wheelchair or oxygen concentrator on your own. Medicare requires a written order from your treating physician or other qualified practitioner. That order must include your name or Medicare ID number, a description of the item, the quantity, the practitioner’s name and signature, and the date.
For certain higher-cost or higher-risk items, there’s an additional step: your doctor must have conducted a face-to-face encounter with you before writing the order, and the complete order must be submitted to the supplier before the equipment is delivered. For other items, the order simply needs to be on file before the supplier submits a claim for payment. In practice, this means your doctor’s office and the DME supplier coordinate behind the scenes, but you should expect the process to take a few days rather than being instant.
What DME Costs With Insurance
Under Original Medicare (Part B), you typically pay 20% of the Medicare-approved amount for durable medical equipment after meeting your annual Part B deductible. Medicare covers the remaining 80%. So if Medicare approves a wheelchair at $1,000 and you’ve already met your deductible, your share would be $200.
Some equipment is rented rather than purchased, which spreads your 20% coinsurance over monthly payments instead of one lump sum. Oxygen equipment, for instance, is usually rented for a set period. If you have a Medicare Advantage plan or supplemental insurance, your out-of-pocket costs may differ depending on your plan’s specific terms.
How Medicare Selects Contract Suppliers
Medicare has historically used a competitive bidding program to control costs on certain off-the-shelf items like back braces and knee braces. Suppliers submit bids to serve specific geographic areas, and CMS awards contracts to those offering competitive prices while meeting quality and financial standards. Contract suppliers must accept Medicare’s payment amount as full payment, with no balance billing.
As of January 2024, the most recent round of competitive bidding contracts has expired, and Medicare is in a temporary gap period while it develops the next round. During this gap, any Medicare-enrolled DME supplier in a former competitive bidding area can provide the affected items, with payment rates adjusted based on Consumer Price Index changes. Not all DME categories are subject to competitive bidding, so for many items, you can use any enrolled supplier regardless of bidding cycles.
How to Spot a Fraudulent DME Supplier
DME fraud is one of the most common types of Medicare fraud. The typical scheme involves unsolicited phone calls or ads offering “free” equipment, often back braces, knee braces, or genetic testing kits. The supplier then bills Medicare for items you didn’t need or never received.
A few rules of thumb can help you avoid these scams. Medicare will never call you to sell you anything or show up at your home to offer equipment. If someone contacts you out of the blue offering free medical supplies, that’s a red flag. Don’t accept offers of money or gifts in exchange for receiving medical equipment. Legitimate DME suppliers work from a physician’s order for a documented medical need. They don’t cold-call patients or recruit through social media ads promising no-cost devices.
If you suspect a supplier is billing for equipment you didn’t request, you can review your Medicare Summary Notice for unfamiliar charges and report discrepancies to Medicare directly.
Choosing the Right DME Supplier
Your doctor’s office may recommend a specific supplier, but you generally have the freedom to choose any Medicare-enrolled supplier in your area (with competitive bidding restrictions noted above). When comparing options, verify that the supplier is Medicare-enrolled and accredited. You can check enrollment status through Medicare’s online supplier directory.
Beyond credentials, pay attention to practical factors: whether the supplier delivers to your area, how quickly they can fulfill orders, whether they offer setup assistance and training on complex equipment, and how responsive they are when you call with questions. A good DME supplier functions as an ongoing resource, not just a one-time delivery service, especially for equipment like CPAP machines or oxygen systems that require regular supply refills and occasional troubleshooting.