This section covers a wide variety of medical and surgical supplies, as well as some DME-related supplies and accessories. Medicare generally covers DME-related supplies, accessories, maintenance, and repair under the prosthetic devices provision.
Sterile water, saline and/or dextrose, diluent/flush, 10 ml
Sterile water/saline, 500 ml
Sterile saline or water, metered dose dispenser, 10 ml
Refill kit for implantable infusion pump
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)
Supplies for maintenance of insulin infusion catheter, per week
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each
Infusion set for external insulin pump, non needle cannula type
Continued
Infusion set for external insulin pump, needle type
Syringe with needle for external insulin pump, sterile, 3 cc
Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each
Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each
Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each
Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each
Alcohol or peroxide, per pint
Alcohol wipes, per box
Betadine or phisohex solution, per pint
Betadine or iodine swabs/wipes, per box
Chlorhexidine containing antiseptic, 1 ml
Urine test or reagent strips or tablets (100 tablets or strips)
Blood ketone test or reagent strip, each
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips
Platforms for home blood glucose monitor, 50 per box
Normal, low and high calibrator solution / chips
Replacement lens shield cartridge for use with laser skin piercing device, each
Spring-powered device for lancet, each
Lancets, per box of 100
Cervical cap for contraceptive use
Continued
Temporary, absorbable lacrimal duct implant, each
Permanent, long term, non-dissolvable lacrimal duct implant, each
Permanent implantable contraceptive intratubal occlusion device(s) and delivery system
Paraffin, per pound
Diaphragm for contraceptive use
Contraceptive supply, condom, male, each
Contraceptive supply, condom, female, each
Contraceptive supply, spermicide (e.g., foam, gel), each
Disposable endoscope sheath, each
Adhesive skin support attachment for use with external breast prosthesis, each
Tubing for breast pump, replacement
Adapter for breast pump, replacement
Cap for breast pump bottle, replacement
Breast shield and splash protector for use with breast pump, replacement
Polycarbonate bottle for use with breast pump, replacement
Locking ring for breast pump, replacement
Sacral nerve stimulation test lead, each
Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access
Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.)
Disposable drug delivery system, flow rate of 50 ml or greater per hour
