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Durable Medical Equipment Section

Policy Name	Policy ID Number	Date Modified
Bioimpedance Devices for Detection and Management of Lymphedema	DME82	09/01/2023
Cooling Devices Used in the Home Setting	DME07	07/01/2024
Cranial Electrostimulation Therapy (CES)	DME83.06	01/01/2024
Definitive Lower Limb Prostheses	DME18	09/01/2024
Durable Medical Equipment, Prosthetic and Orthotic Replacements, Duplicates, Repairs, and Upgrades to Existing Equipment	DME75	09/01/2024
Electrical Bone Growth Stimulators (Osteogenic Stimulation)	DME83.11	10/01/2023
Electrical Stimulation for the Treatment of Arthritis	DME83.10	08/01/2024
Electrical Stimulation for the Treatment of Wounds	DME83.09	07/01/2024
Electromagnetic Therapy	DME83.13	01/01/2024
External Trigeminal Nerve Stimulation for the Treatment of Attention Deficit Hyperactivity Disorder	DME83.14	05/01/2024
Functional Neuromuscular Electrical Stimulation	DME83.04	02/01/2024
Galvanic Stimulation	DME83.01	02/01/2024
General Medical Necessity Guidance for Durable Medical Equipment, Prosthetic, Orthotics and Supplies (DMEPOS)	DME88	01/01/2024
H-wave Stimulation	DME83.02	01/01/2024
Insulin Infusion Pumps, Automated Insulin Delivery and Artificial Pancreas Device Systems	DME77	01/01/2024
Interferential Current Stimulation	DME83.07	04/01/2024
Microcurrent Stimulation (MENS)	DME83.03	02/01/2024
Myoelectric Prosthetic and Orthotic Components for the Upper Limb	DME80	08/01/2024
Negative Pressure Wound Therapy in the Outpatient Setting	DME42	12/01/2023
Noninvasive Ventilators in the Home Setting	DME87	09/01/2023
Oxygen Concentrators	DME91	11/01/2023
Postsurgical Home Use of Limb Compression Devices	DME90	01/01/2024
Power Wheelchairs: Group 3	DME37	11/01/2023
Powered and Microprocessor-Controlled Knee and Ankle-Foot Prostheses and Microprocessor-Controlled Knee-Ankle-Foot Orthoses	DME81	01/01/2024
Powered Exoskeleton for Ambulation and Rehabilitation	DME89	04/01/2024
Threshold Electrical Stimulation as a Treatment of Motor Disorders	DME83.05	02/01/2024
Tumor Treatment Field Therapy (TTFT)	DME85	04/01/2024
Ultrasonic Bone Growth Stimulators (Osteogenic Stimulation)	DME83.12	06/01/2024
Upper Extremity Rehabilitation System with Brain-Computer Interface	DME94	04/01/2024


	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.