Medicare DME stands for durable medical equipment, a category of devices and supplies that Medicare Part B covers when a doctor prescribes them for use in your home. This includes items like wheelchairs, walkers, hospital beds, oxygen equipment, and blood sugar monitors. To qualify for coverage, the equipment must be medically necessary, meaning your healthcare provider has determined you need it to manage a condition or disability.
What Makes Equipment “Durable”
Not every medical item counts as DME under Medicare’s rules. To qualify, an item must meet four criteria: it can withstand repeated use, it serves a medical purpose, it isn’t generally useful to someone who isn’t sick or injured, and it’s appropriate for use in the home. A wheelchair fits all four. A box of bandages does not, because it’s disposable rather than reusable. Home modifications like grab bars or ramps also fall outside the DME category, even though they serve a medical-related purpose.
Common DME items include hospital beds, oxygen concentrators, CPAP machines for sleep apnea, nebulizers, walkers, canes, manual and power wheelchairs, and continuous glucose monitors for diabetes management. Supplies that go along with covered equipment, like tubing for a CPAP or test strips for a glucose monitor, are typically covered as well.
How Coverage Works Under Part B
Medicare Part B pays for DME, not Part A (which covers hospital stays). Your doctor or another qualified provider, such as a nurse practitioner or physician assistant, must write a prescription specifying what you need. For some equipment, Medicare requires additional documentation explaining why the item is medically necessary for your situation. If your condition changes over time, your doctor needs to submit a new, updated order.
You must get your equipment from a supplier enrolled in Medicare’s program. Enrolled suppliers are required to obtain accreditation from a CMS-approved organization and post a $50,000 surety bond. If you buy or rent from a supplier that isn’t Medicare-enrolled, Medicare will not pay the claim, and you’ll be responsible for the full cost.
What You Pay Out of Pocket
After you meet the annual Part B deductible ($257 in 2025), Medicare covers 80% of the approved amount for DME. You pay the remaining 20% as coinsurance. If you have a Medigap (supplemental) plan, it may pick up some or all of that 20%.
The “approved amount” isn’t necessarily the sticker price of the equipment. Medicare sets payment rates for each item, and enrolled suppliers who accept assignment agree to charge no more than that amount. This is an important detail: if your supplier accepts assignment, your 20% coinsurance is based on Medicare’s rate, not a higher retail price.
Renting vs. Buying Equipment
Medicare handles some DME as a rental and other items as a purchase, depending on the category. Equipment like oxygen concentrators is rented for a set period (typically 36 months for oxygen), after which ownership may transfer to you. Items you’re likely to need long-term, such as a standard wheelchair, may follow a capped rental structure where you rent month to month and Medicare converts it to a purchase after 13 months of payments. Other items, like glucose monitors and prosthetics, are purchased outright.
During a rental period, the supplier is responsible for maintenance and repairs. Once you own the equipment, Medicare may still cover reasonable repair costs, but you’re responsible for routine upkeep.
Items That Require Prior Authorization
Certain categories of DME require prior authorization before Medicare will pay. This means your supplier must submit a request and receive approval before delivering the item. The categories currently on the required prior authorization list include:
- Power wheelchairs and scooters: all power-operated vehicles and power wheelchair groups
- Lower limb prosthetics: advanced prosthetic legs and feet with microprocessor or hydraulic components
- Orthotic braces: certain back and knee braces
- Pneumatic compression devices: used for circulation problems or lymphedema
- Pressure-reducing support surfaces: specialized mattresses and overlays for wound prevention
Prior authorization adds time to the process, so if you need one of these items, expect a waiting period while Medicare reviews the clinical documentation. Your doctor’s office and the supplier typically handle the paperwork, but it helps to confirm the request has been submitted and approved before you take delivery.
Continuous Glucose Monitors as DME
Continuous glucose monitors (CGMs) are one of the more commonly searched DME items. Medicare covers them, but you need to meet specific clinical criteria. You must have a diabetes diagnosis, and your prescribing provider must confirm you’ve been trained on using the device. Beyond that, you need to meet at least one additional requirement: you’re being treated with insulin, or you have a documented history of problematic low blood sugar episodes.
For the low blood sugar pathway, Medicare looks for either recurring episodes where glucose dropped below 54 mg/dL despite attempts to adjust treatment, or a single severe episode at that level where you needed someone else’s help to recover. These criteria ensure CGMs go to patients whose diabetes management genuinely benefits from continuous monitoring rather than periodic finger sticks.
How Pricing Is Set
Medicare uses a fee schedule to determine how much it pays for each DME item. For years, a competitive bidding program helped set prices in many metropolitan areas by requiring suppliers to submit bids for contracts. The most recent round of competitive bidding contracts expired at the end of 2023, and as of 2024, Medicare is in a temporary gap period while it develops the next round.
During this gap, Medicare adjusts payment rates in former competitive bidding areas based on previous contract prices updated for inflation using the Consumer Price Index. In areas that were never part of competitive bidding, separate fee schedule rules apply. The practical result for you is that payment amounts vary by region, and your coinsurance will reflect whatever rate applies in your area.
Tips for Getting DME Covered Smoothly
The most common reasons for DME claim denials are paperwork problems: a missing or incomplete prescription, documentation that doesn’t clearly establish medical necessity, or using a supplier that isn’t enrolled in Medicare. Before you commit to any equipment, verify that your supplier is Medicare-enrolled (you can check on Medicare’s supplier directory online), confirm your doctor has submitted the required order, and ask whether prior authorization is needed for your specific item.
If Medicare denies a claim, you have the right to appeal. Denials are sometimes overturned when additional documentation is provided, particularly for items where the initial paperwork didn’t fully explain the medical need. Your supplier and doctor’s office can help with the appeals process, and the denial notice itself will include instructions on how to proceed.