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Durable Medical Equipment Section

Policy Name	Policy ID Number	Date Modified
Bioimpedance Devices for Detection and Management of Lymphedema	DME82	08/01/2022
Cooling Devices Used in the Home Setting	DME07	08/01/2022
Cranial Electrostimulation Therapy (CES)	DME83.06	02/01/2023
Definitive Lower Limb Prostheses	DME18	01/01/2023
Durable Medical Equipment, Prosthetic and Orthotic Replacements, Duplicates, Repairs, and Upgrades to Existing Equipment	DME75	12/01/2022
Electrical Bone Growth Stimulators (Osteogenic Stimulation) Policy Version Effective 03/01/2023: Electrical Bone Growth Stimulators (Osteogenic Stimulation)	DME83.11	12/01/2022
Electrical Stimulation for the Treatment of Arthritis	DME83.10	09/01/2022
Electrical Stimulation for the Treatment of Wounds	DME83.09	09/01/2022
Electromagnetic Therapy	DME83.13	02/01/2023
External Trigeminal Nerve Stimulation for the Treatment of Attention Deficit Hyperactivity Disorder	DME83.14	05/01/2022
Functional Neuromuscular Electrical Stimulation	DME83.04	04/01/2022
Galvanic Stimulation	DME83.01	02/01/2023
General Medical Necessity Guidance for Durable Medical Equipment, Prosthetic, Orthotics and Supplies (DMEPOS)	DME88	12/01/2022
H-wave Stimulation	DME83.02	02/01/2023
Insulin Infusion Pumps, Automated Insulin Delivery and Artificial Pancreas Device Systems	DME77	07/01/2022
Interferential Current Stimulation	DME83.07	06/01/2022
Microcurrent Stimulation (MENS)	DME83.03	02/01/2023
Myoelectric Prosthetic and Orthotic Components for the Upper Limb	DME80	10/01/2022
Negative Pressure Wound Therapy in the Outpatient Setting	DME42	10/01/2022
Noninvasive Ventilators in the Home Setting	DME87	10/01/2022
Oxygen Concentrators	DME91	01/01/2023
Postsurgical Home Use of Limb Compression Devices	DME90	01/01/2023
Power Wheelchairs: Group 3	DME37	11/01/2022
Powered and Microprocessor-Controlled Knee and Ankle-Foot Prostheses and Microprocessor-Controlled Knee-Ankle-Foot Orthoses	DME81	12/01/2022
Powered Exoskeleton for Ambulation	DME89	12/01/2022
Threshold Electrical Stimulation as a Treatment of Motor Disorders	DME83.05	02/01/2023
Ultrasonic Bone Growth Stimulators (Osteogenic Stimulation)	DME83.12	06/01/2022


	The Blue Cross and/or Blue Shield Plans comprising The Regence Group serve Idaho, Oregon, Utah and much of Washington state. The Regence Group and each of its affiliate Plans are independent licensees of the Blue Cross and Blue Shield Association.