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Durable Medical Equipment


Durable Medical Equipment (DME) Limitations (4/1/2023) The list of codes is provided for reference purposes only and may not be all inclusive. Listing of a code does not imply that the service described by the code is a covered or non-covered health service. Please refer to the Fee Schedule for coverage. These limitations serve as guidance for all Medicaid members (regardless of ACO attribution status) with the expectation that providers document medical necessity to justify services or items provided in excess of these limitations.


Durable Medical Equipment (DME) Acquisition Process (08/14/14)

Adaptive Equipment for Basic Activities of Daily Living(bADLS) (01/20/22)

Adaptive Positioning Seats, including Car Supports (05/24/23)

Ambulatory Assistive Aids (07/26/23)

Apnea Monitor (01/11/23)

Assistive Listening Devices (09/07/23)

Augmentative Communication Devices (11/17/22)

Blood Pressure Monitor Set-Up: Automatic Blood Pressure Monitor (01/11/23)

Breast Pumps (8/15/2023)

Compression Garments (03/22/23)

Durable Medical Equipment (DME) Repairs/Modifications (01/20/22)

External Infusion Pump (07/26/23)

Humidifiers (05/24/23)

Incontinence Supplies (8/15/2023)

Jaw Motion CPM Device (04/05/22)

Neuromuscular Stimulator (03/22/23)

Neuroprosthetics/Neuroorthotics (NP/NO) (8/30/22)

Nocturnal Enuresis Alarm (1/1/2022)

Nutritional Therapy-Enteral & Parenteral (See Procedure Criteria)

Oximeter Criteria (09/07/23)

Oxygen and Oxygen Equipment (08/30/22)

Paraffin Bath (01/31/22)

Pediatric Liquid Oral Supplementation (09/03/21)

Pediatric Scales (see scales)

Positioning Wedge (05/24/23)

Prosthetics and Orthotics (08/30/22)

Scales (07/26/23)

Shower Chair (09/03/21)

Special Needs Protective Beds (07/26/23)

Suction Device (06/27/23)

Traction - Home Unit (04/05/22)

Transfer Boards and Other Devices (05/05/23)

Toileting Equipment (05/05/23)

Ultraviolet Light (07/26/23)

Ventilator and Accessories (06/27/23)

Vision Care (10/15/19)

Wheelchair Rule, Definitions and Coding information for Vermont Medicaid Providers (12/1/2022)