What OTs Should Know About Durable Medical and Adaptive Equipment

Adaptive Equipment to Enhance Independence in Daily Living 

Adaptive equipment (AE) and durable medical equipment (DME) play vital roles in rehabilitation across diverse practice settings and throughout the lifespan. These tools offer compensatory strategies that support individuals in engaging more independently and safely in daily occupations.  

Occupations can include:  

• Activities of daily living (ADL)
• Instrumental activities of daily living
• Health management
• Rest and sleep
• Education
• Work
• Leisure and social participation

Related CE courses for OTs: Providing Control of Devices in the Environment for Play, Independence, and Participation 

Adaptive equipment for ADLs 

For example, introducing a front-wheeled walker can enhance functional mobility for someone who was previously homebound. This allows for greater participation in community activities such as work or leisure.  

Similarly, a toilet riser (or elevated toilet seat) can provide the additional height and stability needed for an individual to safely and independently manage toileting tasks. This can also reduce the risk of falling in the bathroom.  

In pediatric settings, a built-up utensil may support a child with decreased grip strength or fine motor control in developing self-feeding skills, promoting independence during mealtime and supporting developmental milestones. For adults in the workplace, an ergonomic keyboard or adjustable desk setup can help individuals with upper extremity limitations reduce strain and maintain productivity, allowing continued participation in meaningful vocational roles.   

These devices can be part of a temporary or long-term intervention strategy. For example, a dressing stick might only be necessary in the early post-operative recovery phase to adhere to movement restrictions after an elective joint replacement whereas more chronic, progressive conditions might require more permanent or customized adaptive solutions that evolve over time. 

However, this term is often used loosely by equipment providers, which can lead to confusion between adaptive equipment and durable medical equipment (DME), obscuring important distinctions between these categories. 

Durable medical equipment 

The Centers for Medicare and Medicaid Services (CMS) defines durable medical equipment as equipment and supplies ordered by a healthcare provider for everyday or extended use. To qualify for insurance coverage, including Medicare, DME generally must meet the following criteria: 

• Primarily serve a medical purpose
• Not be useful in the absence of illness or injury
• Ordered or prescribed by a physician
• Reusable and able to withstand repeated use
• Appropriate for use in the home (excluding hospitals or skilled nursing facilities)
• Intended to improve, restore, or maintain function
• Maximize the patient’s function consistent with medical needs
• Not be excluded by insurance policies or regulations
• Have an expected lifespan of at least three years.

It is important to clearly understand what devices are classified as DME. Examples include: 

• Blood sugar monitors and test strips
• Oxygen tanks
• Infusion pumps
• Nebulizers and medications
• Suction pumps
• Continuous Positive Airway Pressure (CPAP) devices and accessories 
• Hospital beds and related accessories (rails, trapeze bars)
• Patient lifts
• Traction equipment

Most rehabilitation practitioners agree that many of these devices fall outside their typical scope of recommendation. However, certain DME, often categorized as “mobility assistive equipment,” are frequently recommended across rehabilitation settings. These include: 

• Canes (excluding white canes for the blind)
• Crutches
• Walkers
• and powered wheelchairs or scooters.

Confusion is understandable, as this term often overlaps with the DME category of mobility assistive equipment. Precise and consistent terminology is essential both for accurate clinical documentation and for navigating insurance coverage processes. 

Insurance coverage for adaptive equipment and durable medical equipment 

The distinction between AE and DME is most important when it comes to insurance reimbursement and funding. Many insurance plans only cover equipment that serves a clear medical purpose. Equipment that is considered non-medical usually won’t be covered. 

For example, according to the International Classification of Diseases (ICD-10), impaired walking is a medical condition. Typically, that makes devices like crutches, canes, walkers, and wheelchairs eligible for coverage under DME. On the other hand, items like bath benches or shower chairs are usually seen as “personal convenience items” because they can be used without a medical condition, so they often aren’t covered. Grab bars are considered “self-help” devices and are generally not covered. However, equipment like urinals may be covered if the person is medically confined to bed. 

These coverage decisions are guided by Medicare’s National Coverage Determinations Manual, which classifies medical versus non-medical equipment based on federal regulations. 

Medicare 

Medicare Part B covers many DME items, but only if both the prescribing physician and the equipment supplier are enrolled in Medicare. After meeting the deductible, patients typically pay 20% of the Medicare-approved amount. Medicare also allows renting equipment when appropriate. 

Medicaid 

Medicaid coverage for DME varies by state but generally covers equipment that is medically necessary, cost-effective, reusable, and appropriate for home use. Coverage depends on meeting Medicaid’s strict definitions.  

Private insurance 

Many private insurance companies (e.g., Blue Cross Blue Shield, United Health, Humana, Cigna) offer partial or full coverage for DME, often with similar rules to Medicare. However, coverage varies widely, so policyholders must check with their insurers about what’s covered and what costs to expect.  

Because private insurers may differ in what they deem “medically necessary,” practitioners must be skilled at writing strong, evidence-based justifications for DME. This includes linking the device to the patient’s occupational performance and functional goals, diagnosis, and limitations, and clearly explaining how the DME supports safety, independence etc. 

Veterans Affairs (VA) 

The VA offers various programs for veterans who served honorably in the military. Some programs, like Tricare for Life, supplement Medicare by covering costs Medicare does not. However, DME orders must be made through VA facilities or providers authorized by the VA to qualify for coverage. 

Practical tips for therapists who work with AE and DME 

• Get a mentor: Seek out an experienced practitioner who has a strong background in making equipment recommendations for patients and their families or caregivers. This mentor could be someone at your workplace, a former professor or colleague from school, or another therapist within your professional network or community.
• Review your state practice act thoroughly: Study your state’s regulations to understand your professional scope and responsibilities related to equipment recommendations. This foundational knowledge will help you practice safely and effectively.
• Research insurance policies relevant to your practice: Familiarize yourself with coverage criteria and reimbursement policies from major insurers such as Medicare, Medicaid, Veteran Affairs, and private insurance companies. Focus on the insurers most frequently encountered in your clinical setting. Make it a point to update your knowledge annually.
• Engage your employer or manager in equipment discussions: Before communicating equipment recommendations to patients, have a clear understanding of what is feasible within your clinical environment. Discuss with your employer or manager the processes involved in obtaining adaptive equipment and durable medical equipment. Inquire about preferred suppliers or vendors, available billing codes for evaluation and treatment, and options for supporting low-income patients and families.
• Collaborate with reputable suppliers active in your setting: Facilitate connections between your supervisor and trusted equipment suppliers who can provide a variety of mobility and adaptive devices such as walkers, crutches, wheelchairs, powered mobility chairs, and other AE.
• Utilize resources from state and national therapy associations: Maintain your memberships in state and federal professional associations to access valuable resources, including forums, webinars, and special interest groups focused on AE and DME.

Conclusion 

Adaptive equipment and durable medical equipment are essential components within rehabilitation that enhance independence, safety, and quality of life across diverse populations and settings. Novice therapists may feel uncertain about making equipment recommendations, risking patients missing out on beneficial resources.

To effectively integrate AE and DME into practice, therapists should become knowledgeable about suppliers, prescription processes, insurance requirements, and state regulations. Comprehensive patient-centered recommendations require ongoing education about cognitive and physical abilities, financial considerations, environmental factors, and timing within the rehabilitation continuum. By developing expertise in these areas, rehabilitation practitioners can serve as valuable advocates and resources for patients’ access to appropriate equipment.