Author(s): Taron Davis, MD, Danyal Tahseen, BS, Rhoda Hijazi, BS
Originally published: September 20, 2013 Last updated: September 11, 2025
Jump to:

Overview and Description

Durable medical equipment (DME) is equipment that is considered medically necessary, as prescribed by a physician, to assist individuals with disabilities, injuries, or chronic health conditions in performing tasks or achieving greater functional independence.  Medicare defines DME as equipment that can withstand repeated use, has a minimum three-year lifespan, serves a medical purpose, and is not useful to someone who is not sick or injured. Mobility-related DME includes items such as manual and power wheelchairs, scooters, canes, walkers, crutches, commode chairs, hospital beds, and patient lifts.1

By 2030, one in six people will be age 60 years or older. Consequently, the demand for DME is projected to rise accordingly.2 Technological advancements, such as AI-powered respiratory systems and telehealth-compatible monitoring tools, are enhancing chronic disease management and expanding access to home-based care.3

DME supports safety, reduces caregiver dependence, and promotes independence in mobility and activities of daily living (ADLs). Selection should involve a multidisciplinary team including physiatrists, therapists, nurses, and social workers, and must account for the patient’s medical condition, environment, and functional goals.

Recent policy and insurance changes have placed greater emphasis on medical necessity and cost-effectiveness, underscoring the importance of staying informed to advocate for appropriate access.3

Relevance to Clinical Practice

DME offers medical, physical, and psychological benefits by promoting independence and reducing reliance on caregivers. Greater autonomy may enhance mental well-being and social engagement for individuals with disabilities. The following table outlines key factors to consider before recommending or prescribing specific equipment.

Durable Medical Equipment – Table 1

Providers should use the International Classification of Functioning, Disability and Health (ICF) framework to assess how DME supports participation, mobility, and quality of life in various environments.4 Appropriately prescribed DME can improve patient safety and independence in activities of daily living (ADLs), such as bathing, dressing, and toileting, as well as transfers and ambulation.

DME also supports instrumental ADLs (IADLs), like community mobility or work, through tools like power wheelchairs, voice controls, and eye-gaze technology. Occupational and physical therapists are central in evaluating client-specific needs to ensure equipment matches patient goals, abilities, and environments.

The figure below, Overview of DME: Commonly used to support mobility, self-care, and activities of daily living. Categories include eating and grooming aids (e.g., universal cuff, adaptive silverware), toileting and bathing devices (e.g., commodes, shower chairs), transfer and bed mobility equipment (e.g., Hoyer lifts, hospital beds), dressing tools (e.g., sock aids, reachers), walking aids (e.g., canes, crutches), wheeled mobility devices (e.g., power wheelchairs, scooters), and assistive robotics (e.g., exoskeletons) (Images are original and powered by OpenAI).

The table below summarizes common ADL and mobility needs, corresponding DME, and the patient factors that guide equipment selection.

ADLs: Benefits and limitations

Durable Medical Equipment – Table 2

Sexual dysfunction

Sexual health is an essential aspect of comprehensive rehabilitation, especially for individuals with spinal cord injury, traumatic brain injury, and other disabling conditions. Physicians should be prepared to address sexual function and dysfunction with sensitivity and clinical knowledge. Many assistive devices can support sexual function, including vibratory stimulators, positioning supports, and prosthetic options, though specific needs vary based on the type of disability.

For more detailed discussion of sexual health and dysfunction management, see the PM&R Knowledge NOW topics Sexuality and Reproduction after SCI and Sexual Dysfunction in Acquired Brain Injury (ABI). These resources offer further context and clinical guidance for SCI and TBI populations and can be utilized in management decisions for individuals with disability more generally.

Mobility devices

Physicians collaborate with physical/occupational therapists to assess the need for DME that improves ambulation and fosters safety. Nearly 19% of older adults in the United States use mobility devices such as walkers, canes, or crutches.6 These aids can enhance gait efficiency, reduce pain, support independence, and lower fall risk. Gait speed improvements have been linked to better overall function and mortality outcomes.7 However, improper selection or use can lead to excessive energy use, poor posture, overuse injuries, or increased fall risk.8 Physical/occupational therapists play a key role in device selection and training to ensure safe and effective use.

Durable Medical Equipment – Table 3

Individuals that are non-ambulatory need a wheeled mobility device. When evaluating a patient, it is crucial to assess each wheelchair component for proper positioning, postural stability, and safety during mobility and ADLs, given that adjustments may significantly impact patient safety. For example, seat angle adjustments may be necessary for postural stability. A pressure relief strategy, such as power tilt or forward lean, along with a pressure-relieving cushion, helps prevent skin injuries. In certain cases, a seating specialist or Assistive Technology Professional (ATP) should be consulted to ensure an appropriate wheelchair prescription is generated.

Insurance coverage and documentation

When prescribing DME, clinicians must verify coverage parameters, including duration, replacement intervals (e.g., wheelchairs every five years; orthoses like ankle foot orthoses (AFOs) every two years), and bundling restrictions that may deny functionally overlapping devices.3Insurers often prioritize coverage of the least expensive device, such as a cane or walker, and may deny wheelchair reimbursement unless there is clear documentation that less supportive aids are insufficient to meet the patient’s mobility needs.9

Coverage considerations also include non-mobility equipment that plays a critical role in supporting individuals with complex medical needs at home. Medicare’s DME includes non-mobility devices like home oxygen, CPAP, nebulizers, diabetic supplies, enteral nutrients, infusion pumps, and wound therapy pumps. Respiratory supplies support individuals with tetraplegia, neuromuscular weakness, or post-acute COVID-19 to improve function and reduce symptoms. These supplies, along with enteral nutrition and wound care, allow patients to return home instead of staying in a facility.

For progressive conditions (e.g., ALS, multiple sclerosis), anticipate future functional decline to preempt coverage gaps. Supplemental resources include local suppliers, online retailers, and disease-specific foundations.10 Thorough documentation is critical to ensure approval. Notes must explicitly link equipment to functional impairments, justifying why lower-cost alternatives (e.g., canes) are inadequate. For example, wheelchair approval requires evidence that mobility-related ADLs cannot be performed with a walker.3 Medicare covers 80% of allowable charges for DME after the deductible, while commercial insurers often adopt CMS criteria but require individual verification.3 Notably, work-related DME may be covered under the Americans with Disabilities Act as a “reasonable accommodation” rather than under traditional medical benefits.

A face-to-face visit documenting medical necessity, expected benefits, and patient/caregiver training is mandatory for many DME prescriptions.11 Over half the encounter must focus on equipment evaluation, including prior therapy demonstrating effective use.11

Recent trends reflect heightened scrutiny of power mobility devices and experimental technologies, with frequent denials citing insufficient medical necessity.3 Coverage disparities persist due to insurer policies, state regulations, and documentation quality, compounded by delays from prior authorization and appeals.3 Clinicians should still discuss non-covered equipment (e.g., adaptive sports devices) for quality-of-life benefits despite exclusion from reimbursement.10

The April Quarterly Update for 2025 to the Medicare Durable Medical Equipment Fee Schedule includes adjustments to payment policies for new and existing  Healthcare Common Procedure Coding System (HCPCS) codes, such has K0739 (manual wheelchair accessory), L4205 (repair of orthotic device) and L7520 (repair or adjustment of prosthetic device) which now include new payment category indicator (LT = labor rates), effective April 1, 2025.12 These updates aid to streamline reimbursement processes and ensure appropriate payment for maintenance services.3

Pediatric considerations

Devices must be age-appropriate, adaptable for growth, and tailored to developmental skills and functional goals:

  • Standers: Prone, supine, and sit-to-stand models support posture, bone health, and alignment while accommodating growth.
  • Gait aids: Reverse walkers and gait trainers help improve balance and motor control in younger children.
  • Wheelchairs: Adaptive strollers and ultralight wheelchairs offer customizable seating for mobility and independence.
  • Recreational equipment: Frame runners and adaptive cycles encourage exercise and community engagement.

Augmentative and alternative communication (AAC) devices are increasingly introduced at younger ages due to early tech proficiency:

  • Low-tech tools: Picture boards or Picture Exchange Communication System (PECS) are ideal for toddlers with language delays.
  • High-tech devices: Eye-gaze tablets or speech-generating apps support children with severe motor impairments.

Key considerations

  • Adjust devices for growth through pediatric growth spurts to ensure proper fit and function.
  • Collaborate with multidisciplinary teams to integrate mobility and communication needs effectively.

By aligning interventions with developmental milestones, clinicians can promote independence, participation, and overall well-being.13

Communication

Clinicians must understand typical communication, literacy, and socialization behaviors to effectively support individuals with disabilities affecting language, such as acquired brain injuries (e.g., traumatic brain injury, stroke) or developmental conditions (e.g., autism, cerebral palsy). This knowledge enables them to guide patients in selecting AAC devices, assistive reading and writing tools, and social media platforms that enhance independence and participation.

For example, AAC devices like speech-generating apps can assist individuals with motor or speech impairments, while text-to-speech tools support those with reading challenges. Social media platforms with accessibility features can also foster connection for those with limited verbal communication. Clinicians should collaborate with specialists like speech-language pathologists and prioritize patient preferences to ensure tools align with individual needs and goals.14

Cutting Edge/Unique Concepts/Emerging Issues

Advancements in consumer electronics – particularly smart phones, smart home and communication technology – have expanded the landscape of assistive technology (AT) equipment options for patients with disabilities. Electronic Aids to Daily Living (EADLs), formerly Environmental Control Units (ECUs), now integrate Wi-Fi and Bluetooth, enabling users to control lighting, appliances, and emergency alerts via mainstream devices like smartphones or virtual assistants. These systems enhance independence for individuals with severe neuromotor impairments, including high cervical spinal cord injury, brainstem stroke, or ALS.

Emerging technologies

Emerging technologies like brain-computer interfaces (BCIs), albeit experimental, show promise for thought-controlled wheelchairs and prosthetics. Eye-gaze systems and AI-powered smart glasses (e.g., Envision Glasses) support real-time object recognition and multilingual assistance. Robotic exoskeletons are evolving from rehabilitation tools to community-based mobility devices, offering improved gait adjustment and sensor-driven adaptability15. Early manufacturing models have also utilized 3D printing in medical devices and orthotics and prosthetics to improve customization and reduce production costs, with evolving oversight by the FDA16,17.

Unique accessibility innovations

The Consumer Electronics Show (CES) 2025 highlighted several groundbreaking technologies aimed at improving accessibility18. One AI-powered navigation device for individuals with visual impairments, known as The Vector, demonstrated 95 percent accuracy in obstacle detection and featured real-time sign language translation. Wearable devices, like the SoundSense Band, convert audio into vibrations to assist users with hearing impairments. Additional innovations in smart home technology focused on sensor-based mobility assistance and customizable sensory interfaces, expanding independence for users with a variety of disabilities.

Community-based DME reuse programs

Community-based DME reuse programs expand access for individuals who are uninsured, underinsured, or unable to afford necessary equipment. In Texas, two prominent examples include Project MEND19 and the Rehabilitation Services Volunteer Project (RSVP)20. These nonprofit organizations collect, sanitize, repair, and redistribute gently used medical equipment such as wheelchairs, walkers, shower chairs, and hospital beds.

Project MEND, based in San Antonio, serves veterans, older adults, and individuals with disabilities statewide. Their services are often critical for patients transitioning from inpatient care who face insurance-related delays or denials 19. RSVP, based in the Greater Houston area, not only provides similar DME redistribution but also offers free physical and occupational therapy evaluations through a network of volunteer clinicians. This added layer ensures that patients receive both the appropriate equipment and the professional support to use it safely and effectively 20. Similar organizations exist throughout the USA and internationally; providers should research these local resources as they can serve as an important safety net, providing alternative means of DME acquisition for individuals in need.

In the United Kingdom, Recycle Now, a national program in partnership with the NHS, provides public drop-off locations and instructions for recycling walking aids and other medical equipment, reinforcing the role of sustainability in healthcare delivery.21

These programs reduce hospital readmissions, improve home safety, and support functional independence while also minimizing environmental waste. Clinicians should be aware of local and international reuse programs and consider referring patients when cost, access, or insurance restrictions present barriers to timely DME acquisition.

Policy and ethical considerations

The Assistive Technology Act (1998), as amended through 2022, ensures state-level support for device loans, funding, and reutilization programs22. It mandates access to:

  • Information about what devices and services are available and where to obtain them
  • Device loan and demonstration and potentially borrowing programs
  • Funding resources for purchasing or acquiring AT
  • Device exchange and recycling programs

Despite this framework, emerging technologies like BCIs and autonomous wheelchairs face regulatory gaps. Ethical concerns persist around equitable access, particularly for experimental neurotechnologies.

Gaps in Knowledge/Evidence Base

DME is widely available; however, it is often underutilized in the chronically disabled population. A 2007 study on DME use found that fewer than half of chronically disabled Medicare beneficiaries and less than one-quarter of the newly disabled received any DME from Medicare23. A 2023 study of over 4.5 million Medicaid-enrolled pediatric patients found that only 17.1% used DME, ranging from 10.1% to 60.9% depending on clinical complexity24.

Barriers to DME utilization include insufficient physician awareness, limited education on device options, and a lack of clear prescribing guidelines to inform appropriate device selection and timing. Multidisciplinary assessments, such as therapy team recommendations, can underscore the importance of DME in improving function, preventing injury, and fostering independence. Educating physicians on DME benefits and simplifying prescribing guidelines may further improve utilization rates. Patients may also lack awareness of available options or avoid devices due to self-image concerns or denial of their condition. Financial challenges persist, as many adaptive devices and assistive technologies are not covered by insurance, leaving patients unable to afford essential items25. Educational resources and peer support can increase acceptance of DME, while further research is needed to explore its role in improving quality of life, reducing complications, and preventing hospital readmissions26.

In summary, there is a pressing need for

  • Evidence-based prescribing guidelines for clinicians
  • Wider integration of multidisciplinary functional assessments
  • Patient-centered education initiatives
  • Policy reforms to expand DME coverage
  • Longitudinal studies evaluating DME impact on quality of life and healthcare utilization

References

  1. Gov. Durable medical equipment (DME) coverage. Medicare.gov. 2022 Available from: https://www.medicare.gov/coverage/durable-medical-equipment-coverage.html
  2. IMARC Group. Durable Medical Equipment Market Size and Growth 2033. 2024.
  3. Centers for Medicare & Medicaid Services (CMS). 2025 Medicare Parts A & B Premiums and Deductibles. 2024 Available from: https://www.cms.gov/newsroom/fact-sheets/2025-medicare-parts-b-premiums-and-deductibles
  4. The ICF: An Overview. Centers for Disease Control. Available from: https://www.cdc.gov/nchs/data/icd/icfoverview_finalforwho10sept.pdf
  5. Asia Spinal Injury Network. DME 2022 Booklet. 2022 Available from: https://asia-spinalinjury.org/wp-content/uploads/2023/03/DME-2022-Booklet-10.20.22.pdf
  6. Bluethmann SM, Flores E, Campbell G, Klepin HD. Mobility Device Use and Mobility Disability in U.S. Medicare Beneficiaries With and Without Cancer History. J Am Geriatr Soc. 2020;68(12):2872-80.
  7. Middleton A, Fritz SL, Lusardi M. Walking speed: the functional vital sign. J Aging Phys Act. 2015;23(2):314-22.
  8. Thies SB, Bates A, Costamagna E, Kenney L, Granat M, Webb J, et al. Are older people putting themselves at risk when using their walking frames? BMC Geriatr. 2020;20(1):90.
  9. UnitedHealthcare. Durable Medical Equipment, Orthotics, Medical Supplies, and Repairs/Replacements. 2025 Available from: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/dme-equipment-orthotics-ostomy-medical-supplies-repairs-replacements.pdf
  10. GoodRx. Does Medicare Cover Durable Medical Equipment (DME)? 2025 Available from: https://www.goodrx.com/insurance/medicare/dme-medicare-coverage
  11. Medical News Today. Medicare and Medical Devices: Coverage, Options, and Costs. 2025 Available from: https://www.medicalnewstoday.com/articles/how-to-get-a-medical-device-approved-for-medicare
  12. U.S. Department of Health & Human Services. April Quarterly Update for 2025 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). 2025. https://www.hhs.gov/guidance/document/april-quarterly-update-2025-durable-medical-equipment-prosthetics-orthotics-and-supplies
  13. Murphy, Kevin P., Mary A. McMahon, and Amy Houtrow, eds. Pediatric Rehabilitation: Principles and Practice. Sixth edition. New York, NY: Springer Publishing Company, LLC, 2021. Print.
  14. Cerebral Palsy Guide. Communication Devices for Children With Cerebral Palsy. 2025. Available from: https://www.cerebralpalsyguide.com/blog/communication-devices/
  15. Formlabs. 3D printing medical devices: A practical look at applications in healthcare. Available from: https://formlabs.com/blog/3d-printing-medical-devices/
  16. RapidMade. 3D printing in the medical industry: Additive manufacturing for custom prosthetics, orthotics, and devices. Available from: https://rapidmade.com/3d-printing/in-the-medical-industry/
  17. U.S. Food & Drug Administration (FDA). 3D printing medical devices. Available from: https://www.fda.gov/medical-devices/products-and-medical-procedures/3d-printing-medical-devices
  18. CES 2025 Innovations. Revolutionizing Accessibility: Innovative Technologies at CES 2025 in Las Vegas. 2025 Available from: https://www.ces.tech/
  19. Project MEND. Restoring independence for people living with disability. Available from: https://www.projectmend.org/
  20. Rehabilitation Services Volunteer Project (RSVP). Adult medical equipment. Available from: https://www.rsvptexas.org/adult-equipment. Recycle Now. Walking aids recycling information. Available from: https://www.recyclenow.com/recycle-an-item/walking-aids
  21. Assistive Technology Act of 1998, Pub. L. No. 105-394, 112 Stat. 3627. 2022.
  22. Iwashyna TJ, Christie JD. Low use of durable medical equipment by chronically disabled elderly. J Pain Symptom Manag. 2007;33(3):324-30.
  23. Hotz GA, Sprecher E, Bastianelli L. Categorization of a Universal Coding System to Distinguish Use of Durable Medical Equipment and Supply in Pediatric Patients Using Medicaid. JAMA Netw Open. 2023;6(10):e2336993. doi:10.1001/jamanetworkopen.2023.36993.
  24. Sehgal S. The Enterprise of Health: An Evaluation of the Accessibility of Durable Medical Equipment in Low-Income Households. University Scholar Projects. 2021.
  25. Werner NE, et al. Older Adults and Management of Medical Devices in the Home. PMC. 2017.

 Original Version of the Topic

Lyssa Y. Sorkin, MD, Emma Michel, OTR/L. Durable medical equipment that supports activities of daily living, transfers and ambulation. 9/20/2013

Previous Revision(s) of the Topic

Natasha Lynn Romanoski, DO and Kala Swope, OTR/L. Durable medical equipment that supports activities of daily living, transfers and ambulation. 9/7/2018

Kimberly Seidel-Miller, MD, Moriah Kane, MS OTR/L, Ellen Farr, MD, Hannah Von Arb, PT, DPT, NCS. Durable Medical Equipment that Supports Activities of Daily Living, Transfers and Ambulation. 5/11/2022

Author Disclosure

Taron Davis, MD
Nothing to Disclose

Danyal Tahseen, BS
Nothing to Disclose

Rhoda Hijazi, BS
Nothing to Disclose