Medicare fee schedule for DME & CPAP

As far as the replacement schedules, I THINK that it's working differently now.

In the "old days" (before 2013 or so), the DME's would replace items as often as the replacement schedule permitted. But this led to some scamming. DME's often placed people on automatic replacement schedules whether they needed it or not. Some people (especially those with good Medicare Supplements) accepted that as the usual practice and have a closet full of extra supplies. Meanwhile, the DME's had a nice, steady income, and maybe some people were happy to sell their extra stuff.

Medicare has cracked down on that practice in that they now require the DME to document WHY the replacement is required. The same schedule of replacement applies--i.e. you can get a new mask every quarter and a new headgear every 6 months, no sooner, but now, in addition to the time passed, you must also show that you need it. So if your water tank cracks 3 months in, you may have a problem getting a new one because six months has not passed. Likewise, if you want a new water tank at 6 months, you have to tell the DME why you NEED it to get it covered.

This is how it now works as far as I know.

So far, proving need is up to your honesty and that of the DME . . .

True, Chunky. Just a little more work for less money for the DME's.

can someone point out this honest dme to me
you mean there is one somewhere

They are only human. Like us, they struggle to keep from drowning in a system that has neither their interests in mind--or ours.
Many of us have been adversaries because of this system; and now some of us must lie down with the sinners we most strongly rebuke.
I kind of feel like a snake charmer. Imagine me!
Edit: One DME I've dealt with is honest--Sadly, they are not in network.
---(cpap.com, the sponsors of this forum)

Janknitz wrote:
Medicare has cracked down on that practice in that they now require the DME to document WHY the replacement is required. The same schedule of replacement applies--i.e. you can get a new mask every quarter and a new headgear every 6 months, no sooner, but now, in addition to the time passed, you must also show that you need it. So if your water tank cracks 3 months in, you may have a problem getting a new one because six months has not passed. Likewise, if you want a new water tank at 6 months, you have to tell the DME why you NEED it to get it covered.

This is how it now works as far as I know.

Great advice, as always!

Yes, the automatic shipment of supplies without the patient asking for them is now no longer accecptable by Medicare. I, for one NEVER would let any DME automatically ship supplies to me, so I basically am NOT affected by that change.

"My" current & ongoing experience with getting supplies from local DMEs has not really changed since I got on Medicare.

A good enough reason to Medicare for me wanting X supply (as often as Medicare says it is allowable) is simply that "I" need it. I have to express a desire & need to the DME.

DMEs accept my requesting / ordering X supply as having met that burden.
NOTHING additional needs to be done.

When I need something, I send an E-Mail to my contact at my DME (about 1 mile away) & it is mailed to my residence. My DME sells primarily Respironics & I use ResMed, so everything has to be ordered & mailed to me. I actually prefer that procedure because I get everything in sealed ResMed bags. And at the most, I get it in 5 days, usually within 2 days.