Facility Take-Home DME and Medical Supplies
Defines Anthem Medicare Advantage reimbursement stance for DME and medical supplies dispensed by inpatient or outpatient hospital facilities for take-home use and specifies when facility claims will be denied or allowed; affects providers, facilities, and DME/supply vendors serving Anthem Medicare Advantage members.
No material clinical or coverage changes in this revision.
Facility Take-Home DME and Supplies — Coverage Criteria
Facility take-home DME and supplies coverage criteria
Covered when ALL of the following are met:
ALL of the following
- Anthem Medicare Advantage does not allow reimbursement of durable medical equipment (DME) and medical supplies dispensed by inpatient or outpatient hospital facilities for take‑home use unless provider, state, federal, or CMS contracts and/or requirements indicate otherwise.
Facility claims submitted for DME and medical supplies billed with revenue codes denoting take‑home use will be denied.
- To be considered for reimbursement, claims for take‑home DME and medical supplies should be submitted by a DME/supply vendor.
Reimbursement is based on the contract or negotiated rate for participating vendors, or the out‑of‑network fee schedule/negotiated rate for nonparticipating vendors.
Exceptions
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.