Durable Medical Equipment

Durable Medical Equipment (DME) Limitations - 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 service unit limitations serve as guidance for all Vermont 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. Medically Unlikely Edits (MUEs) define the maximum units of service for each HCPCS/CPT code that a provider would report under most circumstances for a single patient on a single date of service. Units that exceed MUEs will be denied.

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

Adaptive Equipment for Basic Activities of Daily Living(bADLS) (11/08/23)

Adaptive Positioning Devices (includes car supports, bed supports, and positioning cushions or wedges other than wheelchair cushions) (08/30/24)

Ambulatory Assistive Aids (07/26/23)

Apnea Monitor (02/22/24)

Assistive Listening Devices (09/07/23)

Augmentative Communication Devices (02/22/24)

Blood Pressure Monitor Set-Up: Automatic Blood Pressure Monitor (03/27/24)

Bone Growth Stimulator (6/26/2024)

Breast Pumps (1/11/2024)

Compression Garments (1/1/2024)

Conductive Garments for Electrical Stimulation Devices (08/30/2024)

Durable Medical Equipment (DME) Repairs/Modifications (03/27/24)

External Infusion Pump (08/30/24)

Humidifiers (05/24/23)

Incontinence Supplies (8/15/2023)

Jaw Motion CPM Device (11/08/23)

Neuromuscular Electrical Stimulators (08/30/24)

Neuroprosthetics/Neuroorthotics (NP/NO) (11/08/23)

Nocturnal Enuresis Alarm (1/1/2022)

Nutritional Therapy-Enteral & Parenteral- see Nutritional Supplementation and Support

Oximeter Criteria (09/07/23)

Oxygen and Oxygen Equipment (08/30/22)

Paraffin Bath (01/31/22)

Pediatric Liquid Oral Supplementation- see Nutritional Supplementation and Support

Pediatric Scales (see scales)

Positioning Wedge (05/24/23)

Positive Airway Pressure PAP) Devices for the Treatment of Obstructive Sleep Apnea in the Home Setting (6/26/2024)

Prosthetics and Orthotics (11/08/23)

Scales (07/26/23)

Shower Chair (02/22/24)

Special Needs Protective Beds (07/26/23)

Standers (referred to as Standing Frames in InterQual®) (08/30/24)

Suction Device (06/27/23)

Toileting Equipment (05/05/23)

Traction - Home Unit (11/08/23)

Transcutaneous Electrical Nerve Stimulation (TENS) (08/30/24)

Transfer Boards and Other Non-lift Transfer Devices (08/30/24)

Ultraviolet Light (07/26/23)

Ventilator and Accessories (06/27/23)

Vision Care (03/27/24)

Wheelchair Accessories (06/26/2024)

Wheelchair Cushions and Seating (06/26/2024)