{ "name": "Procedure Cost Checker Medicare DME Coverage and Allowable", "title": "Medicare DME Coverage and Allowable", "url": "https://procedurecostchecker.com/datasets/medicare-dme-coverage-and-allowable/", "csv": "https://procedurecostchecker.com/datasets/medicare-dme-coverage-and-allowable.csv", "markdown": "https://procedurecostchecker.com/datasets/medicare-dme-coverage-and-allowable/index.md", "computed_at": "2026-10-19", "license": "https://procedurecostchecker.com/terms", "headline": "The Medicare DME Coverage and Allowable carries 3 published figures read from 2 sources' own pages, under different breakdowns, so no one range is stated, read 12 September 2026.", "quotes": [ "The Medicare DME Coverage and Allowable carries 3 published figures read from 2 sources' own pages, under different breakdowns, so no one range is stated, read 12 September 2026.", "2 of the 7 named sources read in full publish a figure; 5 publish none, read 12 September 2026.", "Medicare DME Coverage and Allowable, rule Medicare payment share: median 80 percent across 1 source, read 12 September 2026.", "Medicare DME Coverage and Allowable, rule beneficiary coinsurance: median 20 percent across 1 source, read 12 September 2026.", "Medicare DME Coverage and Allowable, rent or purchase purchase: median 20 percent across 1 source, read 12 September 2026." ], "citation": "\"Procedure Cost Checker Medicare DME Coverage and Allowable\", updated 2026-10-19, https://procedurecostchecker.com/datasets/medicare-dme-coverage-and-allowable/.", "changed_since": null, "national": { "unit": "%", "n": 3, "median": 20, "min": 20, "max": 80, "p25": 20, "p75": 80, "mean": 40, "units": { "%": 3 }, "published_sources": 2, "named_sources": 7, "read_sources": 7, "not_published": 5, "published_share": 0.286 }, "by_axis": { "rule": { "Medicare payment share": { "%": { "n": 1, "median": 80, "min": 80, "max": 80, "p25": 80, "p75": 80, "mean": 80 } }, "beneficiary coinsurance": { "%": { "n": 1, "median": 20, "min": 20, "max": 20, "p25": 20, "p75": 20, "mean": 20 } } }, "rent or purchase": { "purchase": { "%": { "n": 1, "median": 20, "min": 20, "max": 20, "p25": 20, "p75": 20, "mean": 20 } } } }, "rows": [ { "source": "CMS - payment policies for DMEPOS items and services", "url": "https://www.cms.gov/medicare/payment/fee-schedules/durable-medical-equipment-prosthetic-devices-prosthetics-orthotics-supplies/payment-policies-dmepos-items-services", "figure": "80%", "value": 80, "unit": "%", "vat": null, "axis": { "rule": "Medicare payment share" }, "retrieved_at": "2026-09-12", "quote": "The Medicare allowed payment amount is equal to 80% of the lower of the supplier’s actual charge for the item or service or the fee schedule amount for the item or service, less any unmet Part B deductible.", "source_class": "primary-government", "text_sha256": "8d77a2b4296a4e7a797102aeb91973c1bfab3e968a434f8a1a34b0b6f1dd8740" }, { "source": "CMS - payment policies for DMEPOS items and services", "url": "https://www.cms.gov/medicare/payment/fee-schedules/durable-medical-equipment-prosthetic-devices-prosthetics-orthotics-supplies/payment-policies-dmepos-items-services", "figure": "20%", "value": 20, "unit": "%", "vat": null, "axis": { "rule": "beneficiary coinsurance" }, "retrieved_at": "2026-09-12", "quote": "The Medicare beneficiary is responsible for 20% of the lower of either the actual charge or the fee schedule amount for the item or service, plus any unmet Part B deductible.", "source_class": "primary-government", "text_sha256": "8d77a2b4296a4e7a797102aeb91973c1bfab3e968a434f8a1a34b0b6f1dd8740" }, { "source": "Medicare - coverage of DME and other devices (publication 11045)", "url": "https://www.medicare.gov/publications/11045-medicare-coverage-of-dme-and-other-devices.pdf", "figure": "20%", "value": 20, "unit": "%", "vat": null, "axis": { "rent or purchase": "purchase" }, "retrieved_at": "2026-09-12", "quote": "to the cost of replacing the item) for repairs. You pay the other 20%.", "source_class": "primary-government", "text_sha256": "6e848871374a86374de10a476402011aab712a9b3a25a23295f659583296c5eb" } ], "not_published": [ { "source": "CMS - DMEPOS fee schedule", "url": "https://www.cms.gov/medicare/payment/fee-schedules/dmepos", "retrieved_at": "2026-09-12", "reason": "read in full and no accepted figure on the page" }, { "source": "Medicare.gov - durable medical equipment (DME) coverage", "url": "https://www.medicare.gov/coverage/durable-medical-equipment-dme-coverage", "retrieved_at": "2026-09-12", "reason": "read in full and no accepted figure on the page" }, { "source": "Medicare.gov - wheelchairs and scooters coverage", "url": "https://www.medicare.gov/coverage/wheelchairs-scooters", "retrieved_at": "2026-09-12", "reason": "read in full and no accepted figure on the page" }, { "source": "Medicare - coverage of wheelchairs and scooters (publication 11046)", "url": "https://www.medicare.gov/publications/11046-medicare-coverage-of-wheelchairs-scooters.pdf", "retrieved_at": "2026-09-12", "reason": "read in full and no accepted figure on the page" }, { "source": "NHS England - personal wheelchair budgets, frequently asked questions", "url": "https://www.england.nhs.uk/personalisedcare/personal-health-budgets/personal-wheelchair-budgets/frequently-asked-questions/", "retrieved_at": "2026-09-12", "reason": "read in full and no accepted figure on the page" } ], "sources": [ { "url": "https://www.cms.gov/medicare/payment/fee-schedules/dmepos", "label": "CMS - DMEPOS fee schedule", "license": "the publisher's own terms; quoted for reporting and comment" }, { "url": "https://www.cms.gov/medicare/payment/fee-schedules/durable-medical-equipment-prosthetic-devices-prosthetics-orthotics-supplies/payment-policies-dmepos-items-services", "label": "CMS - payment policies for DMEPOS items and services", "license": "the publisher's own terms; quoted for reporting and comment" }, { "url": "https://www.medicare.gov/coverage/durable-medical-equipment-dme-coverage", "label": "Medicare.gov - durable medical equipment (DME) coverage", "license": "the publisher's own terms; quoted for reporting and comment" }, { "url": "https://www.medicare.gov/coverage/wheelchairs-scooters", "label": "Medicare.gov - wheelchairs and scooters coverage", "license": "the publisher's own terms; quoted for reporting and comment" }, { "url": "https://www.medicare.gov/publications/11046-medicare-coverage-of-wheelchairs-scooters.pdf", "label": "Medicare - coverage of wheelchairs and scooters (publication 11046)", "license": "the publisher's own terms; quoted for reporting and comment" }, { "url": "https://www.medicare.gov/publications/11045-medicare-coverage-of-dme-and-other-devices.pdf", "label": "Medicare - coverage of DME and other devices (publication 11045)", "license": "the publisher's own terms; quoted for reporting and comment" }, { "url": "https://www.england.nhs.uk/personalisedcare/personal-health-budgets/personal-wheelchair-budgets/frequently-asked-questions/", "label": "NHS England - personal wheelchair budgets, frequently asked questions", "license": "the publisher's own terms; quoted for reporting and comment" } ], "methodology": "Every row is a verbatim sentence read from the named source's own page through our fetch service on the date shown, hash-pinned to the stored read (the sha of the page's visible text; the raw page is mirrored to R2). 2 of the 7 named sources that could be read published a usable figure; 5 published none and are recorded as not published, never filled in; 0 could not be read (blocked, dead or unreachable) and count nowhere. The headline figures (median, minimum, maximum, quartiles) are over ONE figure per source for each breakdown it prices, in % (a source's median where its page yielded several accepted sentences for one breakdown), so a page that gives figures for several breakdowns gives one for each and N counts 3 figures, never sentences; 7 candidate sentence(s) were refused by a reviewer with the reason recorded. The fuller derivation this dataset is chartered to grow into (not yet what the figures above are; they are each source's own published figure as read): one row per HCPCS code per state per quarter from the DMEPOS fee schedule - the allowed amount, whether the item rents or is bought, the competitive-bidding status - joined to the coverage rule that governs it in Medicare's own words and to the buyer's 20% coinsurance; the derivation is the one figure neither CMS nor any seller publishes: the GAP between the retail price index above and the Medicare allowable for the same class of item, per state, and how that gap has moved across the quarterly fee-schedule releases", "embed": "

3 published figures

Medicare DME Coverage and Allowable, across 2 sources, read 12 September 2026

Source: Procedure Cost Checker Medicare DME Coverage and Allowable
" }