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HealthPartners

Coverage criteria policies

Labor charges, repairs, and parts for Durable Medical Equipment (DME) including prosthetics and orthotics

These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Does not require prior authorization except as stated in #4 below under Indications that are covered.

Coverage

Generally covered subject to the indications listed below and following limits from your member contract:

Indications that are covered

  1. Coverage is limited to eligible items that meet the HealthPartners Plan coverage criteria.
  2. Coverage is eligible when item is non-functional due to normal wear and tear.
  3. Coverage is eligible to accommodate growth requirements, or if needed due to a change in a medical condition which affects the fit/function of the item or if the member is dependent on the item for constant/continuous support in order to carry out all activities of daily living.
  4. Rental of medically necessary equipment, while the member's owned equipment is being repaired, is covered for one month. Prior authorization of the rental item will be required only on those items that currently require prior authorization. Please refer to healthpartners.com to view items that require prior authorization.

Indications that are not covered

Labor charges, repairs and parts which are not eligible for coverage include, but are not limited to:

  1. Items which are damaged or destroyed by misuse, abuse, or carelessness.
  2. Items which are considered duplicate or similar to an already eligible item, such as member owns a power wheelchair used for primary mobility and a manual wheelchair as a back-up. The manual wheelchair is considered a duplicate/similar item; therefore labor/repairs are not covered.
  3. Charges that exceed the replacement cost of the item.
  4. Service call charges or charges for repair estimates.
  5. Items which are primarily for education, vocation, comfort, convenience or recreation, such as knee braces primarily for sports activities.
  6. Household equipment such as, but not limited to, air purifiers and air conditioners.
  7. Household fixtures such as, but not limited to, elevators and ramps.
  8. Home modifications, including installation.
  9. Vehicle, car, or van modifications.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy contact Member Services at 952-883-7979 or 1-800-233-9645.

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Policy activity

  • 07/01/1997 - Date of origin
  • 06/01/2017 - Effective date
Review date
  • 06/2017

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