Pop quiz.

Will Medicare automatically pay for new durable medical equipment when the age of the patient’s existing device exceeds its reasonable useful life (RUL)?

The answer is … no.

Many suppliers are surprised to learn that, with the exception of oxygen equipment, age is not, in and of itself, sufficient justification for RUL replacement.

Next Episode: Thursday, August 22, 2024

Medicare determines RUL based on the length of service during which the beneficiary uses the equipment, not the actual age of the equipment.

That is the first consideration, but there is a second …

After establishing the length of service exceeds the RUL for the equipment, suppliers must determine the equipment is malfunctioning before Medicare will approve – and pay for – a replacement. Medicare uses the term “irreparable wear.”

Chapter 5, Replacement, of the CGS Supplier Manual states:

“Irreparable wear refers to deterioration sustained from day-to-day usage over time where a specific event cannot be identified. Replacement of equipment due to irreparable wear takes into consideration the reasonable, useful lifetime of the equipment. If the equipment has been in continuous use by the beneficiary on either a rental or purchase basis for the equipment’s useful lifetime, then the beneficiary may elect to obtain a new piece of equipment.”

Suppliers must document the functional deficit giving rise to the replacement. Medicare defines irreparable damage as cases where the costs to repair exceed 60 percent of a new replacement unit’s purchase price.

So, while time is a consideration, it is not the only consideration. In fact, Medicare’s hope and expectation is the equipment will last longer than the RUL – usually five years – depending on the item. With proper maintenance and care, some items may function properly for considerably longer.