BlueCross BlueShield of Tennessee Medical Policy Manual

DME (Durable Medical Equipment)

• Cervical Traction Devices for Home Use

• Continuous Home Pulse Oximetry

• Continuous Passive Motion (CPM) Device in the Home Setting

• End Diastolic Pneumatic Compression Boot as a Treatment of Peripheral Vascular Disease

• Hemodialysis in the Home

• Home Apnea Monitoring / Home Cardiorespiratory Monitoring

• H ome Spirometry

• Hospital-Grade Breast Pump

• Intraoral Devices for the Treatment of Headaches

• Laser Device for Obtaining Blood Sample

• Light Emitting Diode (LED) Therapy

• M icroprocessor-Controlled Prostheses for the Lower Limb

• Negative Pressure Wound Therapy in the Outpatient Setting

• N on-invasive Positive Pressure Ventilators (In-Home Use)

• Oral Negative Pressure Therapy Devices for The Treatment of Sleep Apnea

• Oscillating Devices for the Treatment of Respiratory Conditions

• Percutaneous Electrical Nerve Stimulation (PENS), Percutaneous Neuromodulation Therapy (PNT) and Percutaneous Electrical Nerve Field Stimulation (PENFS)
• Pneumatic Compression Pumps
• Powered Exoskeleton for Ambulation in Individuals with Lower-Limb Disabilities
• Spinal Unloading Devices for the Treatment of Low Back Pain

• Transcutaneous Electrical Nerve Stimulation (TENS) and Transcutaneous Afferent Patterned Stimulation (TAPS)

• U pper Limb Myoelectric Orthosis
• Wearable Cardioverter Defibrillator

This document has been classified as public information.