The replacement of an item past the five-year lifetime will be considered in cases of irreparable wear if the item has been in continuous use by the patient, on either a rental or purchase basis, for the equipment’s useful lifetime.

• Irreparable wear:
• Irreparable wear refers to deterioration sustained from day-to-day usage over time and a specific event cannot be identified.


• In cases involving irreparable wear, the Reasonable Useful Lifetime (RUL) of the equipment is taken into consideration, and in no case can it be less than five years old.


• Computation of the useful lifetime is based on when the equipment is delivered to the patient, not the age of the equipment.


• A physician’s written order is needed to reaffirm the medical necessity of the item.


• If a PAP machine is replaced following the five-year RUL, there must be a face-to-face evaluation by the treating physician documenting that the patient continues to use and benefit from the PAP machine. There is no requirement for a new sleep test or trial period. Note: If a DME item reaches its five-year life expectancy, is in good working order and meets the patient’s medical needs, it should not automatically be replaced.