Medical Equipment – Equipment

Equipment

A Pineywoods Home Medical Equipment distributes a wide range of HME / Home Medical Equipment products and supplies.

Respiratory Equipment:

  • Oxygen Concentrators
    (Full in home set-up)
  • Oxygen conserving devices
  • Nebulizers
  • Portable Tanks
    E-TANKS AND B-TANKS
  • BIPAP
  • CPAP
  • Suction machines

Mobility Equipment:

  • Wheelchairs (all sizes)
  • Gel wheelchairs cushions
  • Quad canes/Straight canes
  • Walkers (With or without wheels)
  • Rollators/Cash or thru your CBA program
  • Lift chairs-thru CBA program

Specialized Bedding:

  • Semi Electric hospital beds
  • Low air-loss mattresses
  • Trapeze bars
  • Patient lifts

Miscellaneous Equipment:

  • Transfer benches thru CBA/Cash/Medicaid
  • Over bed tables thru Medicaid/Cash/CBA
  • Bedside commodes
  • Shower Benches thru Medicaid/Cash/CBA

Commodes

  • A commode is only covered when you are physically incapable of utilizing regular toilet facilities. For example:
    1. You are confined to a single room, or
    2. You are confined to one level of the home environment and there is no toilet on that level, or
    3. You are confined to the home and there are no toilet facilities in the home.
  • Heavy-duty commodes are covered if you weigh over 300 pounds. Commodes with detachable arms are covered if your body configuration requires extra width, or if the arms are needed to transfer in and out of the chair.

Positive Airway Pressure Devices (CPAPs and Bi-Level Devices for Obstructive Sleep Apnea)

  • Continuous Positive Airway Pressure (CPAP) Devices are covered only if you have obstructive sleep apnea (OSA).
  • You must have an overnight sleep study performed in a sleep laboratory or through a special, in-home sleep test to establish a qualifying diagnosis of Obstructive Sleep Apnea.
  • Medicare will also pay for replacement masks, tubing and other necessary supplies.
  • After the first three months of use, you will be required to verify if you are benefiting from using the device and how many hours a day you are using the machine. Per Medicare, a face-to-face visit with your physician that documents an improvement of your symptoms is required no sooner than 31 days and no later than 91 days from the set-up date. A data report from your sleep equipment which documents that the PAP has been used for at least 4 hours per night on 70% of nights during a 30-day consecutive period is required.
  • If the CPAP device is not working, or if you cannot tolerate the CPAP machine, your doctor may also try to use a different device called a Bi-Level or a Respiratory Assist device, and Medicare can consider this for coverage as well.
  • Talk with your provider if you are having problems adjusting to the therapy. There are a lot of variations that can make the therapy more comfortable for you.

Hospital Beds

  • A hospital bed is covered if one or more of the following criteria (1-4) are met:
    1. You have a medical condition which requires positioning of the body in ways not feasible with an ordinary bed. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed, or
    2. You require positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain, or
    3. You require the head of the bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration. Pillows or wedges must have been considered and ruled out, or
    4. You require traction equipment which can only be attached to a hospital bed.
  • A semi-electric bed is covered if you require frequent changes in body position and/or have an immediate need for a change in body position.
  • Heavy-duty/extra-wide beds can be covered if you weigh over 350 pounds.
  • The total electric bed is not covered because it is considered a convenience feature

Mobility Products: Canes, Walkers, Wheelchairs

  • Essentially the new Mobility Assistive Equipment regulations will ensure that Medicare funds are used to pay for:
  • Mobility needs for daily activities within the home
  • The lowest level of equipment required to accomplish these tasks.
  • The most medically appropriate equipment (that meets your needs, not your wants)
  • Will a cane or crutches allow you to perform these activities in the home?
  • If not, will a walker allow you to accomplish these activities in the home?
  • If not, is there any type of manual wheelchair that will allow you to accomplish these activities in the home?
  • Medicare requires that your physician and provider evaluate your needs and expected use of the mobility product you will qualify for.
  • They must determine which is the least level of equipment needed to help you be mobile within your home to accomplish daily activities by asking the following questions:
    • Your home must be evaluated to ensure it will accommodate the use of any mobility product.
    • You may also be asked to see a physical therapist or occupational therapist to determine the best fit and equipment selection.

Nebulizers

  • Nebulizer machines, medications and related accessories are usually covered if you have obstructive pulmonary disease, but can also be covered to deliver specific medications if you have HIV, Cystic Fibrosis, brochiectasis, pneumocystosis, complications of organ transplants, or for persistent thick or tenacious pulmonary secretions.
  • If at any time you stop using your medications, please notify your provider.

Oxygen

  • Oxygen is covered if you have significant hypoxemia in a chronic stable state when:
  • You have a severe lung disease or hypoxemia that might be expected to improve with oxygen therapy, and
  • Your blood gas levels or oxygen saturation levels indicate the need for oxygen therapy, and
  • Your oxygen study was performed by a qualifying physician or sleep lab, and
  • Alternative treatments have been tried or deemed clinically ineffective.
  • Group I Criteria: mmHG = 55, or saturation = 88%
  • For these results you must return to your physician between 9-12 months after the initial visit to discuss whether your oxygen therapy should continue for lifetime or for a shorter period if the need is expected to end. Typically, you will not have to be retested when you return to your physician for the follow-up visit.
  • Group II Criteria: 56-59 mmHg, or 89% saturation
  • For these results, you must return for another office visit with your physician to discuss your oxygen therapy and you will also have to be retested within 3 months of the first test to continue therapy for lifetime or until the need is expected to end.
  • Group III Criteria: mmHg = 60 or saturation = 90% is considered to be not medically necessary.
  • Categories/Groups are based on the test results to measure your oxygen:

Oxygen will be paid as a rental for the first 36 months. After that time, if you still need the equipment, Medicare will no longer make rental payments on the equipment. However, if equipment is still necessary, your provider will continue to provide the equipment to you for an additional 24 months. During this two year service period, Medicare will pay your provider for refilling your oxygen cylinders and for a semi-annual maintenance fee.

After 60 months of service through Medicare you may choose to receive new equipment.

Patient Lifts

  • A lift is covered if transfer between a bed and a chair, wheelchair, or commode requires the assistance of more than one person and, if without the use of a lift, you would be bed confined.
  • An electric lift mechanism is not covered; because it is considered a convenience feature.
  • Patient lifts are a capped rental item, and that means they cannot be purchased outright. You will own the equipment after Medicare makes 13 payments toward the purchase of the equipment.

Support Surfaces

  • Group 1 products are designed to be placed on top of a standard hospital bed or home mattresses. They can utilize gel, foam, water or air, and are covered if you are:
  • Completely immobile OR
  • Have limited mobility or any stage ulcer on the trunk or pelvis (and one of the following):
    • impaired nutritional status
    • fecal or urinary incontinence
    • altered sensory perception
    • compromised circulatory status
  • Multiple stage II ulcers on the pelvis or trunk while on a comprehensive treatment program for at least a month using a Group 1 product, and at the close of that month, the ulcers worsened or remained the same. (Monthly follow-up is required by a clinician to ensure that the treatment program is modified and followed. This product is only covered while ulcers are still present.) OR
  • Large or multiple Stage III or IV ulcers on the trunk or pelvis (Monthly follow-up is required by a clinician to ensure that the treatment program is modified and followed. This product is only covered while ulcers are still present.) OR
  • A recent myocutaneous flap or skin graft for an ulcer on the trunk or pelvis within the last 60 days where you were immediately placed on Group 2 or 3 support surface prior to discharge from the hospital and you have been discharged within the last 30 days.
  • Group 2 products take many forms, but are typically powered pressure reducing mattresses or overlays. They are covered if you have one of three conditions:
  • Your provider cannot deliver these products to you without a written order from your doctor, nor can they get the documentation at a later date because if they do, Medicare can never make payment for those products to you or your provider. So please be patient with your provider while they collect the required documentation from your physician.