Home medical equipment is:
- Able to withstand repeated use
- Primarily and customarily used to serve a medical purpose
- Not generally useful to a person in the absence of illness or injury
- Appropriate for use in the home.
Coverage of home medical equipment is subject to medical necessity. We do not cover equipment that:
- Cannot reasonably be expected to perform a therapeutic function in an individual case
- Substantially exceeds the level required for the treatment of the illness or injury
Rental and purchase
Please note the following guidelines:
- We may allow charges for renting home medical equipment when a member rents equipment for a short period of time.
- If the rental exceeds the period of time allowed by the prescription, we require documentation of medical necessity.
- Reimbursement for rental items can't exceed contracted purchase price.
Repairs and service
When necessary, we cover repair and servicing charges for patient-owned equipment due to normal use. Repair charges are not covered if they are greater than the cost of replacing the equipment. Refer to the replacement guidelines below.
All claims for home medical equipment repairs or servicing are subject to review by Premera. If not covered by the manufacturer's warranty, Premera covers the rental fee for necessary loaner equipment while member-owned equipment is being repaired or serviced.
For replacement of home medical equipment, the referring physician must submit a new prescription, and the supplier must indicate the condition of the present equipment on the prescription. Claims for replacement are subject to our review.
Each supply provided should be itemized using appropriate HCPC codes and modifiers.
Generally, the benefits for external prosthetic devices (including fitting expenses), with the exception of intraocular lens, are provided when such devices are used to replace all or part of an absent body limb, or to replace all or part of the function of a permanently inoperative or malfunctioning body organ.
In general, foot orthotics (shoe inserts) and therapeutic shoes (orthopedic) are covered when prescribed for the condition of diabetes or for corrective purposes.