Durable Medical Equipment (DME)  refers to repeated use medical equipment intended to be utilized at home. Many things can fall into this category from canes to oxygen equipment. As a chiropractic expert and in my clinical practice, some common DME seen prescribed may be braces, slings, or devices for management of pain such as a TENS unit. DME can be helpful in reducing the cost of in-office procedures (aka prescribing someone an ice pack for home use instead of billing for cryotherapy every visit) or can be a very costly and low-yield addition to a care plan. 

There is conflicting evidence that bracing results in improvements in pain and function in patients with low back pain.¹ There are situations that a low back brace may be reasonable, but this indication should be outlined in the supportive documentation by the medical provider prescribing the intended use of the brace. A low back brace, for example, may be helpful in the short term in empowering a patient to return to their manual labor job without fear of aggravating their pain. These can be helpful situational tools to bolster the treatment plan, however, should not be seen as reasonable and customary to prescribe to every person with low back pain or who is in an MVA. 

What are reasonable and customary costs of DME?

If you have seen DME prescribed, you have also probably seen a wide variety of costs associated with these items, as well. You may question as to how one back brace can retail over the counter at $75.00 and how the prescribed DME version can be billed at $800.00. Some resources to start with that may be helpful in determining if costs far exceed reasonable and customary value for an item can be the CMS Fee Schedule² or the GSA Advantage website³. 

1. Kreiner DS, Matz P, Bono CM, et al. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain. Spine J. 2020;20(7):998-1024. doi:10.1016/j.spinee.2020.04.006
2. https://www.cms.gov/medicare/payment/fee-schedules/dmepos/dmepos-fee-schedule
3. https://www.gsaadvantage.gov/advantage/ws/main/start_page?store=ADVANTAGE

Dr. Morgan Price is a chiropractor at the Seattle Veterans Affairs Medical Center, Rehabilitative Care Services Department.