Coverage of any medical intervention discussed in a Dean Health Plan medical
policy is subject to the limitations and exclusions outlined in the member's benefit
certificate.
Repairs/Replacement of
Durable Medical Equipment/Supplies
Covered Service:
MP9106
Yes–when meets criteria below
Prior Authorization
Required:
Yes–as shown below
Additional
Information:
Replacement of equipment/supplies due to loss is not a covered
benefit.
Prior authorization is not required for durable medical equipment
repairs rendered by a plan provider which cost less than $250.
Medicare Policy:
Dean Health Plan covers when Medicare also covers the benefit.
BadgerCare Plus
Policy:
Dean Health Plan covers when BadgerCare Plus also covers the
benefit.
Dean Health Plan Medical Policy:
1.0 All of the following criteria are considered when determining if replacement or repair
is appropriate:
1.1 What is the anticipated life expectancy for the equipment.
1.2 Is the equipment in good working order? If a repair is being made to a worn
piece of equipment is it cost-effective to replace it?
1.3 The need and use of the equipment still medically appropriate?
1.4 Safety of the repair?
1.5 Routine or non-routine repair? Routine items may need replacing more
frequently such as wheelchair tires, tubes and batteries.
2.0 Coverage of repairs or replacement of durable medical equipment/supplies requires
prior authorization through the Medical Affairs Division
3.0 Authorization is approved for the most cost-effective option (repair versus
replacement) if:
3.1 The warranty has expired
3.2 Repair or replacement is required due to normal use
Repairs/Replacement of Durable Medical Equipment/Supplies
1 of 2
Coverage of any medical intervention discussed in a Dean Health Plan medical
policy is subject to the limitations and exclusions outlined in the member's benefit
certificate.
Committee/Source
Date(s)
Originated: QA/UR Committee
January 6, 1988
Revised:
February 11, 1998
Utilization Management Committee/Health Services
Utilization Management Committee/Medical Affairs/
DME Specialists
Medical Director Committee/Medical Affairs
Medical Director Committee/Medical Affairs
Reviewed: Health Services
Managed Care Division/ Medical Affairs Department
Managed Care Division / Medical Affairs Department
UMC/CMO/Director UM
UM Committee (UMC)/Director UM/UMC Chair
UM Committee (UMC)/Director UM/UMC Chair
UM Committee (UMC)/Director UM/UMC Chair
UM Committee (UMC)/Director UM/UMC Chair
Reformatted
UM Committee (UMC)/Director UM/UMC Chair
UM Committee (UMC)/Director UM/UMC Chair
UM Committee (UMC)/Director UM/UMC Chair
Medical Director Committee/Medical Affairs
Medical Director Committee/Medical Affairs
Medical Director Committee/Medical Affairs
Medical Director Committee/Medical Affairs
Medical Director Committee/Medical Affairs
Medical Director Committee/Medical Affairs
Medical Director Committee/Medical Affairs
Medical Director Committee/Medical Affairs
Effective: 08/01/2015
Repairs/Replacement of Durable Medical Equipment/Supplies
2 of 2
February 11, 2004
December 17, 2014
May 20, 2015
February 12, 1999
March 20, 2000
April 11, 2001
March 13, 2002
March 12, 2003
March 10, 2004
March 9, 2005
March 8, 2006
May 2006
March 14, 2007
March 12, 2008
April 8, 2009
August 18, 2010
August 25, 2011
August 15, 2012
July 17, 2013
July 16, 2014
December 17, 2014
May 20, 2015
July 15, 2015