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Is It Covered?

Search the A-Z list for a list of covered services. Your coverage and out-of-pocket costs may vary based on who you are and your health plan option.

Durable Medical Equipment

TRICARE covers durable medical equipment (DME) when prescribed by a physician. DME is defined as an item that:

  • Can withstand repeated use;
  • Primarily and customarily serves a medical purpose; and
  • Generally is not useful to an individual in the absence of an injury or illness.

TRICARE covers DME that:

  • Improves, restores, or maintains the function of a malformed, diseased, or injured body part, or can otherwise minimize or prevent the deterioration of the patient's function or condition
  • Maximizes the patient's function consistent with the patient's physiological or medical needs
  • Provides the medically appropriate level of performance and quality for the medical condition present
  • Is not otherwise excluded by the regulation and policy

DME may be rented or purchased. However, the managed care support contractor will decide if a DME should be rented or purchased based on whether it is more economical and appropriate.

TRICARE will cover medically necessary customization or attachments to the DME to accommodate your medical disability, when your physician has prescribed the equipment as medically necessary and appropriate.

TRICARE will also cost share any medically necessary covered accessories and attachments to a DME necessary to make the DME “serviceable” for a particular disability. For example, a car lift that is an accessory to a wheelchair.

TRICARE will pay for repairs to equipment that you own when it is necessary to make the equipment serviceable.

TRICARE will also pay to replace a DME owned by you when:

  • There is a change in the beneficiary's physical condition,
  • There is accidental damage to the DME, or
  • The DME is inoperative and cannot be repaired, or
  • The U.S. Food and Drug Administration have declared the DME adulterated.

Duplicate items (those that serve the same purpose, but may not be an exact duplicate, such as a portable oxygen concentrator as a backup for a stationary oxygen generator) that are essential to provide a fail-safe, in-home, life-support system are covered.

Electric-powered, cart-type vehicles may be cost-shared as an alternate to an electric wheelchair. Benefits will not be extended for the use of both an electric-powered, cart-type vehicle.

TRICARE does not cover:

  • DME for a beneficiary who is a patient in a type of facility that ordinarily provides the same type of DME item to its patients at no additional charge in the usual course of providing its services is excluded.
  • DME available to the beneficiary from a military treatment facility
  • DME with deluxe, luxury, or immaterial features, which increase the cost of the item to the government relative to similar item without those features.
  • Routine periodic servicing, such as testing, cleaning, regulating, and checking which the manufacturer does not require be performed by an authorized technician.
  • Duplicate items of otherwise allowable DME to be used solely as a back-up to currently owned or rented equipment.
  • Expendable items such as incontinent pads, diapers, ace bandages etc.
  • Non-medical equipment (e.g., humidifier, electric air cleaners, exercycle, safety grab bars etc.).
Disclaimer:

This A-Z list of topics is not all inclusive. TRICARE covers most inpatient and outpatient care that is medically necessary and considered proven. However, there are special rules or limits on certain types of care, while other types of care are not covered at all.

Last Updated 12/6/2013