Durable Medical Equipment (DME. a. Items that are not covered include: i. bed related items: bed trays, over-the-bed tables, bed wedges, pillows, custom bedroom equipment, mattresses, including non-power mattresses, custom mattresses and posturepedic mattresses; ii. bath related items: bath lifts, non-portable whirlpools, bathtub rails, toilet rails, raised toilet seats, bath benches, bath stools, hand held showers, paraffin baths, bath mats, and spas; iii. chairs, lifts and standing devices: computerized or gyroscopic mobility systems, roll about chairs, geriatric chairs, hip chairs, seat lifts (mechanical or motorized), patient lifts (mechanical or motorized β manual hydraulic lifts are covered if patient is 2-person transfer), and auto tilt chairs; iv. electric or powered scooters; non-standard customized wheelchairs, motorized or manual; v. fixtures to real property, including ceiling lifts and wheelchair ramps; vi. car/van modifications; vii. air quality items: air conditioners, room humidifiers, vaporizers, air purifiers and electrostatic machines; viii. blood/injection related items: blood pressure cuffs, centrifuges, nova pens and needleless injectors; and ix. other equipment: heat lamps, heating pads, cryounits, cryotherapy machines, electronic- controlled therapy units, ultraviolet cabinets, sheepskin pads and boots, postural drainage board, AC/DC adaptors, enuresis alarms, magnetic equipment, scales (baby and adult), stair gliders, elevators, saunas, any exercise equipment, emergency alert equipment, and diathermy machines. b. The replacement of DME solely because it is old or used is excluded.
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Samples: Medical and Hospital Service Contract, Medical and Hospital Service Contract, Medical and Hospital Service Contract