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Final Policies - Durable Medical Equipment (DME)

Policy # Policy Title Print View
MP-003 Negative Pressure Wound Treatment
MP-006 Thoracic-Lumbo-Sacral Orthosis with Pneumatics
MP-008 Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses
MP-021 Cranial Electrotherapy Stimulation (CES) and Auricular Electrostimulation
MP-038 Continuous Glucose Monitoring
MP-046 Insulin Infusion Pump
MP-065 Medical Management of Obstructive Sleep Apnea Syndrome
MP-073 Interferential Stimulator/Stimulation Devices
MP-078 Home Prothrombin Time Testing (INR Monitoring)
MP-082 Electrical Bone Growth Stimulation of the Appendicular Skeleton
MP-083 Microprocessor-Controlled Prostheses for the Lower Limb
MP-087 Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions
MP-092 Transtympanic Micropressure Applications as a Treatment of Ménière’s Disease
MP-094 Lower Limb Prostheses
MP-123 Lymphedema Pumps/Pneumatic Compression Devices
MP-124 Myoelectric Prosthetic and Orthotic Components for the Upper Limb
MP-157 Threshold Electrical Stimulation as a Treatment of Motor Disorders
MP-164 Actigraphy
MP-201 Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence
MP-203 Noninvasive Positive Pressure Ventilation for Conditions Other Than Obstructive Sleep Apnea
MP-215 Medical Foods and Specialized Formula for the Treatment of Inborn Errors of Metabolism
MP-217 Electrical and Electromagnetic Stimulation in the Treatment of Arthritis
MP-242 Continuous Passive Motion in the Home Setting
MP-247 Pressure-Reducing Support Surfaces
MP-293 Foot Orthotics and Orthopedic Shoes
MP-317 Oxygen Therapy
MP-331 Low-Intensity Pulsed Ultrasound Fracture Healing Device
MP-346 Stretching and Splinting Devices for the Treatment of Joint Stiffness and Contractures
MP-358 Functional Neuromuscular Electrical Stimulation
MP-364 Heating and Cooling Devices Used in the Home Setting
MP-375 Transcutaneous Electrical Nerve Stimulation (TENS)
MP-408 Home Cardiorespiratory Monitoring
MP-464 Interventions for Progressive Scoliosis
MP-515 Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis
MP-524 Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
MP-536 Tumor-Treatment Fields Therapy for Glioblastoma
MP-557 Cardioverter Defibrillators: Wearable or External
MP-575 Powered Exoskeleton for Ambulation in Patients with Lower Limb Disabilities
MP-578 Patient-Controlled End Range of Motion Stretching Devices
MP-607 Speech Generating Devices
MP-636 Artificial Pancreas Device Systems
MP-702 Enteral Feeding Therapy
MP-718 Neuromuscular Electrical Stimulation (NMES)
MP-727 Gait Trainers and Standing Devices
MP-736 Digital Health Therapies for Substance Use
MP-742 Digital Health Therapies for Attention Deficit/Hyperactivity Disorder
MP-750 Digital Health Technologies: Diagnostic Applications
MP-752 Stationary Ultrasonic Diathermy Devices
MP-755 Digital Health Technologies: Therapeutic Applications