Medicare DME Coverage Rules: The Living Reference for Mobility Equipment

Medicare Part B pays for medically necessary durable medical equipment (DME) that a treating practitioner orders for use in the home, and it pays 80 percent of the lesser of the supplier’s charge or the fee schedule amount once the Part B deductible is met. The rules below govern what counts, who can bill, what paperwork must exist before delivery, and how the price is set.

This page is the umbrella reference. Product-specific pages cover manual wheelchairs, power wheelchairs, mobility scooters and the DMEPOS Competitive Bidding Program.

What counts as durable medical equipment

Medicare.gov lists five tests. DME is equipment that is durable (can withstand repeated use), serves a medical purpose, is generally useful only to someone who is sick or injured, is used in the home, and is expected to last at least 3 years. The regulation at 42 CFR 410.38(a) adds the setting rule: Part B pays for DME, “including ventilators, oxygen equipment, hospital beds, and wheelchairs,” when the equipment is used in the patient’s home or in an institution used as a home. A hospital, critical access hospital or skilled nursing facility does not qualify as a home.

Medicare.gov’s covered-item list includes canes, commode chairs, CPAP devices, crutches, hospital beds, walkers, and wheelchairs and scooters, along with oxygen equipment, infusion pumps and glucose monitors.

The Part B framework

Under 42 CFR 414.210(a), Medicare pays 80 percent of the lesser of the actual charge or the fee schedule amount for DME, prosthetics and orthotics. The beneficiary pays the remaining 20 percent coinsurance after meeting the Part B deductible, provided the supplier accepts assignment.

Payment is organized into classes set out in 414.210(b): inexpensive or routinely purchased items, items requiring frequent and substantial servicing, customized items, oxygen, prosthetics and orthotics, other DME (capped rental items), and TENS units. CMS assigns each HCPCS code to a class through program instructions.

Replacement is allowed when an item has been in continuous use for its reasonable useful lifetime, or is lost, stolen or irreparably damaged. The regulation says the reasonable useful lifetime can never be less than 5 years, counted from delivery to the beneficiary, not the age of the equipment.

Enrolled suppliers and assignment

Medicare pays for DME only from suppliers enrolled in Medicare. Medicare.gov draws the line this way: participating suppliers must accept assignment, so they can charge only the coinsurance and deductible based on the Medicare-approved amount. Non-participating suppliers may choose whether to accept assignment, and if they do not, the beneficiary may be charged more. For rented DME, the supplier must accept assignment for every rental month; otherwise the beneficiary pays the full cost up front and Medicare reimburses its share later.

Enrollment rides on the supplier standards in 42 CFR 424.57(c), which include state licensure, telling beneficiaries about rent-or-buy and purchase options, honoring warranties without billing for covered repairs, keeping a staffed physical facility of at least 200 square feet, accreditation and a surety bond.

The written order and face-to-face rules

Every DMEPOS item requires a written order as a condition of payment. 42 CFR 410.38(d)(1) lists the six standard elements: beneficiary name or Medicare Beneficiary Identifier, general description of the item, quantity if applicable, order date, treating practitioner name or NPI, and treating practitioner signature. A treating practitioner is a physician, physician assistant, nurse practitioner or clinical nurse specialist.

Timing depends on the item. For power mobility devices and any item on the Required Face-to-Face Encounter and Written Order Prior to Delivery List, the order must reach the supplier before delivery. For all other DMEPOS, the order must reach the supplier before the claim is submitted.

Items on that list also require the treating practitioner to document a face-to-face encounter with the beneficiary within the 6 months preceding the order date. The encounter can be in person or by telehealth, and it must be about diagnosing, treating or managing the condition for which the equipment is ordered.

The list is drawn from a Master List of items CMS has flagged under 42 CFR 414.234(b): items priced at or above $500 to buy or $50 a month to rent (adjusted annually; $614 and $62 for CY 2026) that appear in a national OIG, GAO or CERT report, items with aberrant billing growth, and items that need a face-to-face encounter or prior authorization by statute. CMS updates the Master List at least annually in the Federal Register.

Prior authorization

CMS also selects Master List items for a Required Prior Authorization List. 42 CFR 414.234 defines prior authorization as a request for “provisional affirmation” of coverage submitted to CMS or its contractor before the item is furnished and before the claim is filed. A provisional affirmation is a preliminary finding that a future claim meets coverage, coding and payment rules. The January 13, 2026 Federal Register notice reported 67 items on the list before its update and added seven codes, effective April 13, 2026. The July 30, 2026 notice reported 74 items and added more, effective October 28, 2026, with prior authorization for upper limb orthoses phased in by state.

Rental versus purchase categories

Inexpensive or routinely purchased items (42 CFR 414.220). Inexpensive equipment is defined by an average purchase price that did not exceed $150 in the base period of July 1986 through June 1987; routinely purchased equipment was bought rather than rented at least 75 percent of the time in that period. Payment can be rental or a lump-sum purchase, and total rental payments may not exceed the purchase fee schedule amount. Canes, walkers and crutches fall here.

Items requiring frequent and substantial servicing (42 CFR 414.222). This class covers ventilators (other than CPAP and bi-level respiratory assist devices), IPPB machines, continuous passive motion machines and other items CMS designates. Payment is monthly rental that continues until medical necessity ends; there is no purchase and no title transfer.

Capped rental items (42 CFR 414.229). Everything else, including most wheelchairs and hospital beds, is capped rental. For items furnished on or after January 1, 2006, Medicare pays a monthly rental amount during the period of medical need for no longer than 13 months of continuous use. The supplier must transfer title to the beneficiary on the first day after the 13th paid month. The monthly amount is 10 percent of the purchase price for the first 3 months and 7.5 percent thereafter; for power wheelchairs furnished on or after January 1, 2011, it is 15 percent for the first 3 months and 6 percent thereafter. Complex rehabilitative power wheelchairs keep a lump-sum purchase option at the time the chair is first furnished.

The fee schedule and rural rates

CMS publishes the DMEPOS fee schedule quarterly. The CMS fee schedule files page lists DME26-A (January 2026), DME26-B (April), DME26-C (July) and DME26-D (October 2026). As of 2026-10-30, no DME27-A file was posted.

The CY 2026 update (MLN Matters MM14326, effective January 1, 2026) applies a 2.0 percent update factor to fee schedule amounts not adjusted with competitive bidding information: the CPI-U increase of 2.7 percent for the 12 months ending June 30, 2025, less a 0.7 percent productivity adjustment.

Fees adjusted with competitive bidding information follow 42 CFR 414.210(g). CMS builds regional prices from single payment amounts, caps them at 110 percent of the national average, and applies separate rural and non-rural amounts. A rural area, per 42 CFR 414.202, is a ZIP code where at least 50 percent of the land area is outside any metropolitan statistical area, plus low-population ZIP codes inside an MSA that were excluded from its competitive bidding area. The ZIP code on the claim decides which rate applies, and CMS updates the rural ZIP code file quarterly.

Because the Competitive Bidding Program has been in a gap period since January 1, 2024, the CMS competitive bidding page says fees in former competitive bidding areas are adjusted to 100 percent of the area’s single payment amount increased by CPI-U, and fees elsewhere use the fully adjusted rates under 414.210(g). MM14326 puts the CY 2026 CPI-U increase for former CBA amounts at 2.8 percent.

How Medicare Advantage differs

Medicare.gov’s comparison page says Medicare Advantage plans “must cover all medically necessary services that Original Medicare covers,” so the DME benefit exists in every plan. The differences are in access: a plan may require network suppliers, referrals, and prior authorization before it covers “certain services or supplies.” Plans have a yearly out-of-pocket limit; Original Medicare does not, but it lets a beneficiary use any supplier that takes Medicare anywhere in the country.

For people with both Medicare and Medicaid, Medicaid.gov states that services covered by both programs are paid first by Medicare, with Medicaid filling in the difference up to the state’s payment limit.

Appeals

Medicare.gov says there are generally 5 levels of appeal in Original Medicare, and each decision letter explains how to move to the next level. For 2026, the minimum amount in dispute for judicial review in federal district court is $1,960; claims can be combined to reach it. Medicare Advantage plans must tell members in writing how to appeal. State Health Insurance Assistance Programs provide free counseling, and a beneficiary can appoint a representative.

What changed recently

• October 28, 2026. The July 30, 2026 Federal Register notice (CMS-6109-N) took effect, adding 20 codes to the Master List (including E2298, power seat elevation for complex rehab power chairs, and K0831, a Group 2 power wheelchair with seat elevator) and expanding both required lists. CMS’s order-requirements page says there are now 105 items on the Face-to-Face Encounter and Written Order Prior to Delivery List.
• October 7, 2026. Per the CBIC Round 2028 timeline, CMS announced registration and bidding dates; registration opens December 1, 2026, the bid window runs January 5 to March 10, 2027, and contracts take effect January 1, 2028.
• April 13, 2026. The January 13, 2026 Master List update took effect: 18 codes added to the Master List (530 items total), eight oxygen codes added to the face-to-face list (83 items), seven codes added to the prior authorization list (74 items).
• January 1, 2026. CY 2026 fee schedule took effect with a 2.0 percent update factor (MM14326).
• December 8, 2025. CMS updated its competitive bidding fact sheet: single payment amounts in the next round are set at the 75th percentile of winning bids, and all product categories (CGMs and insulin pumps, urological and ostomy supplies, hydrophilic catheters, and off-the-shelf back, knee and upper extremity braces) fall under a nationwide remote item delivery program. Wheelchairs and other mobility equipment are not among the announced Round 2028 categories.

Where to check

• Medicare.gov DME coverage: the beneficiary-facing rules and covered-item list.
• CMS DMEPOS fee schedule files: quarterly public use files, including rural ZIP code files.
• CMS DMEPOS order and face-to-face requirements: the current Required Face-to-Face and Written Order Prior to Delivery List, Required Prior Authorization List and Master List.
• CMS DMEPOS Competitive Bidding and the CBIC Round 2028 timeline.
• 42 CFR Part 414 Subpart D and 42 CFR 410.38 on eCFR.
• Medicare.gov appeals and shiphelp.org for free counseling.

Coverage decisions depend on the beneficiary’s medical record and the supplier’s documentation. Readers should confirm specifics with their clinician, supplier or the DME MAC for their jurisdiction.