Understanding Medicare Coverage
for Home Medical Equipment
Plain-language answers to what Medicare Part B covers, what's required, and how CrestCare handles the billing process on your behalf.
Check My Coverage — It's FreeWe Handle Your Medicare Billing
As an enrolled Medicare DMEPOS provider, CrestCare Medical bills Medicare directly. We verify your coverage before providing any equipment, explain exactly what you'll owe (typically 20% after the deductible with Original Medicare), and handle all claims paperwork. You never deal with Medicare billing directly.
Your typical share
20%
after your Part B deductible
Secondary insurance or Medigap often covers this portion
Coverage by Equipment Category
Click any category for details on requirements, documentation, and HCPCS billing codes.
Coverage Requirements
- ✓Diagnosis of obstructive sleep apnea via qualifying sleep study
- ✓Apnea-Hypopnea Index (AHI) ≥ 15 events/hour, OR AHI ≥ 5 with documented symptoms
- ✓Physician order / prescription
- ✓Face-to-face evaluation with your physician
Coverage Details
Medicare covers the CPAP machine rental for the first 13 months (then ownership transfers), plus masks, tubing, and filters on a scheduled basis. An initial 3-month compliance trial is required — you must use the device ≥4 hours/night on ≥70% of nights during any consecutive 30-day period in the first 3 months.
HCPCS Codes
HCPCS: E0601 (CPAP), E0470–E0472 (BiPAP)
Coverage Requirements
- ✓Physician order specifying oxygen flow rate and hours per day
- ✓Blood oxygen saturation ≤ 88% at rest (SpO₂), or qualifying exercise test results
- ✓Certificate of Medical Necessity (CMN) — Form 484.03
- ✓ICD-10 diagnosis code supporting chronic hypoxemia
Coverage Details
Medicare covers the oxygen equipment rental for up to 36 months (then switches to a maintenance-only payment period through month 60). Covered equipment includes stationary concentrators, portable concentrators, liquid oxygen systems, and oxygen-conserving devices.
HCPCS Codes
HCPCS: E1390, E1392, E0431, E0434, E0444
Coverage Requirements
- ✓Physician order specifying wheelchair type
- ✓Documentation that the patient cannot ambulate in the home
- ✓Face-to-face evaluation within 6 months of order
Coverage Details
Standard manual wheelchairs are covered as a capped rental for 13 months (ownership transfers thereafter). Transport chairs (designed for attendant use only) are also covered. Medicare pays 80% of the approved amount after the Part B deductible.
HCPCS Codes
HCPCS: K0001 (standard), K0002 (lightweight), K0003 (ultra-lightweight)
Coverage Requirements
- ✓Face-to-face examination by a physician or treating practitioner within 6 months
- ✓PT or OT mobility evaluation (recommended; required for complex rehab tech)
- ✓Documentation that patient cannot safely self-propel a manual wheelchair
- ✓Documentation of mobility limitation in the home environment
- ✓Prior authorization required for most power mobility devices
Coverage Details
Prior authorization is required for most power wheelchairs and scooters — we submit this on your behalf. The process typically takes 10–14 days. Once approved, Medicare covers 80% after the deductible. Capped rental applies (13 months to ownership).
HCPCS Codes
HCPCS: K0800–K0899 (scooters), K0813–K0899 (power wheelchairs)
Coverage Requirements
- ✓Physician order specifying type of bed and clinical reason
- ✓Documentation of medical necessity (e.g., positioning needs, wound care, breathing difficulty)
- ✓CMN may be required for powered pressure-relief mattresses
Coverage Details
Medicare covers semi-electric or full-electric hospital beds when medically necessary. Coverage also extends to related accessories like side rails and trapeze bars when ordered together with the bed. Capped rental applies.
HCPCS Codes
HCPCS: E0250 (semi-elec), E0260 (full-elec), E0280 (rails), E0910 (trapeze)
Coverage Requirements
- ✓Physician order
- ✓Documentation of mobility impairment or post-surgical need
Coverage Details
Standard walkers, two-wheel walkers, and rollators (four-wheel walkers with seat) are covered. Crutches and canes are also covered with a physician order. These are purchased items, not rental equipment.
HCPCS Codes
HCPCS: E0130 (standard walker), E0143 (folding walker), E0156 (rollator)
Common Medicare Questions
Do I need a referral from my doctor?
Yes. Medicare requires a physician order (prescription) for all covered DME. Your doctor, nurse practitioner, or physician assistant can write the order. If you haven't seen your doctor yet, we can help coordinate the appropriate evaluation.
What's the difference between Medicare Part A and Part B for DME?
Home medical equipment and durable supplies are covered under Medicare Part B, not Part A. Part A covers inpatient hospital care. If you have Part B, you're covered for DME — which includes everything CrestCare provides.
What if I have a Medicare Advantage plan?
Medicare Advantage (Part C) plans cover the same DME as Original Medicare but may have different prior authorization requirements and in-network DME providers. We work with most Medicare Advantage plans. Call us to confirm your specific plan is in our network.
Is there a deductible I have to meet first?
Yes. Medicare Part B has an annual deductible ($257 in 2025). After meeting the deductible, Medicare covers 80% of the approved amount for covered DME. You're responsible for the remaining 20% (the coinsurance). If you have a Medigap or supplemental plan, it typically covers this 20%.
What is a Certificate of Medical Necessity (CMN)?
A CMN is a form your physician completes that documents the medical necessity of certain equipment — such as home oxygen and hospital beds. CrestCare sends the CMN form to your doctor and follows up to ensure it's completed and returned promptly.
What does 'capped rental' mean?
For many items like CPAP machines, wheelchairs, and hospital beds, Medicare pays a monthly rental rate for up to 13 months. After 13 months of rental, you own the equipment outright. CrestCare manages the rental-to-purchase transition and notifies you when ownership transfers.
Ready to Verify Your Coverage?
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