Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) refers to medical equipment or supplies that a patient needs to arrest or reduce functional loss. DMEPOS must be ordered by a physician.

Medically necessary DMEPOS may be leased or purchased (whichever method is least expensive for TRICARE). Claims received for extended rentals are evaluated for the cost benefit of purchasing the equipment. If it is determined that purchasing the equipment is more cost-effective, a letter suggesting that the equipment be purchased is sent to the beneficiary and the provider. The letter notifies the beneficiary that he or she has the option of either leasing or purchasing the equipment. If a beneficiary chooses to continue leasing the equipment, claims are paid only up to the purchase amount. TRICARE does not reimburse any amount over the purchase price. A lease/purchase agreement letter is not sent to beneficiaries for lifetime oxygen and oxygen concentrators.

A prescription requesting DMEPOS and signed by the beneficiary’s physician is required for rental or purchase of DMEPOS. Prescriptions must specify the beneficiary’s diagnosis, the particular type of equipment needed, the reason it is needed, and the duration for which it will be needed.

A certificate of medical necessity (CMN) may be accepted in place of a prescription. A CMN is considered to be valid for three months (unless otherwise specified). A lifetime CMN for oxygen or oxygen equipment is validated every 12 months. Equipment that is needed for more than one year must be reviewed annually to validate continued medical necessity. When a physician completes and signs the CMN, he or she is attesting that the information indicated on the form is correct and that the requested services are medically necessary.  Any time there is a change in the prescription, a new CMN must be submitted.

For more information about DMEPOS, refer to the TRICARE Policy Manual, Chapter 8, Section 2.1 at TRICARE's Manuals Online web page. See the TRICARE Reimbursement Methodologies section of this handbook for more information about DMEPOS reimbursement guidelines.