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  4. Medical Policies
  5. Medical Policies Durable Equipment

Medical Policies Durable Equipment

  • Ambulatory Devices Commercial - Durable Medical Equipment 40

    PDF, 197 KBLast Updated: 05/13/2025

    PDF, 197 KBLast Updated: 05/13/2025

  • Ambulatory Devices Medicaid - Durable Medical Equipment 40

    PDF, 200 KBLast Updated: 05/15/2025

    PDF, 200 KBLast Updated: 05/15/2025

  • Augmentative Communication and Speech Generating Systems Commercial - Durable Medical Equipment 30

    PDF, 305 KBLast Updated: 06/04/2025

    PDF, 305 KBLast Updated: 06/04/2025

  • Augmentative Communication and Speech Generating Systems Medicaid- Durable Medical Equipment 30

    PDF, 341 KBLast Updated: 06/04/2025

    PDF, 341 KBLast Updated: 06/04/2025

  • Automated External Defibrillators (AED) Commercial - Durable Medical Equipment 63

    PDF, 252 KBLast Updated: 05/13/2025

    PDF, 252 KBLast Updated: 05/13/2025

  • Automated External Defibrillators (AED) Medicaid - Durable Medical Equipment 63

    PDF, 304 KBLast Updated: 05/15/2025

    PDF, 304 KBLast Updated: 05/15/2025

  • Compression Stockings, Garments and Devices Commercial - Durable Medical Equipment 04

    PDF, 361 KBLast Updated: 05/13/2025

    PDF, 361 KBLast Updated: 05/13/2025

  • Compression Stockings, Garments and Devices Medicaid - Durable Medical Equipment 04

    PDF, 388 KBLast Updated: 05/13/2025

    PDF, 388 KBLast Updated: 05/13/2025

  • Continuous Glucose Monitoring Systems Commercial - Durable Medical Equipment 10

    PDF, 257 KBLast Updated: 05/13/2025

    PDF, 257 KBLast Updated: 05/13/2025

  • Continuous Glucose Monitoring Systems Medicaid - Durable Medical Equipment 10

    PDF, 315 KBLast Updated: 05/15/2025

    PDF, 315 KBLast Updated: 05/15/2025

  • Continuous Passive Motion Commercial - Durable Medical Equipment 27

    PDF, 220 KBLast Updated: 05/13/2025

    PDF, 220 KBLast Updated: 05/13/2025

  • Continuous Passive Motion Medicaid - Durable Medical Equipment 27

    PDF, 268 KBLast Updated: 05/13/2025

    PDF, 268 KBLast Updated: 05/13/2025

  • Cranial Electrotherapy Stimulation Commercial - Durable Medical Equipment

    PDF, 271 KBLast Updated: 05/13/2025

    PDF, 271 KBLast Updated: 05/13/2025

  • Cranial Electrotherapy Stimulation Medicaid - Durable Medical Equipment 59

    PDF, 264 KBLast Updated: 05/15/2025

    PDF, 264 KBLast Updated: 05/15/2025

  • Cranial Electrotherapy Stimulation Medicare - Durable Medical Equipment 59

    PDF, 281 KBLast Updated: 05/15/2025

    PDF, 281 KBLast Updated: 05/15/2025

  • Diapers and Underpads Medicaid - Durable Medical Equipment 246

    PDF, 354 KBLast Updated: 05/13/2025

    PDF, 354 KBLast Updated: 05/13/2025

  • Electric and Electromagnetic and Ultrasonic Bone Growth Stimulation Commercial - Durable Medical Equipment 09

    PDF, 224 KBLast Updated: 05/15/2025

    PDF, 224 KBLast Updated: 05/15/2025

  • Electric and Electromagnetic and Ultrasonic Bone Growth Stimulation Medicaid - Durable Medical Equipment 09

    PDF, 269 KBLast Updated: 05/13/2025

    PDF, 269 KBLast Updated: 05/13/2025

  • Electric Stimulation Commercial - Durable Medical Equipment 07

    PDF, 376 KBLast Updated: 05/13/2025

    PDF, 376 KBLast Updated: 05/13/2025

  • Electric Stimulation Medicaid - Durable Medical Equipment 07

    PDF, 369 KBLast Updated: 05/13/2025

    PDF, 369 KBLast Updated: 05/13/2025

  • Electrical Stimulation and Electromagnetic Therapy for Wounds Commercial - Durable Medical Equipment 01

    PDF, 253 KBLast Updated: 05/13/2025

    PDF, 253 KBLast Updated: 05/13/2025

  • Electrical Stimulation and Electromagnetic Therapy for Wounds Medicaid - Durable Medical Equipment 01

    PDF, 355 KBLast Updated: 05/15/2025

    PDF, 355 KBLast Updated: 05/15/2025

  • External Insulin Infusion Pump Commercial - Durable Medical Equipment 11

    PDF, 259 KBLast Updated: 05/15/2025

    PDF, 259 KBLast Updated: 05/15/2025

  • External Insulin Infusion Pump Medicaid - Durable Medical Equipment 11

    PDF, 341 KBLast Updated: 05/15/2025

    PDF, 341 KBLast Updated: 05/15/2025

  • Foot Orthotics Commercial - Durable Medical Equipment 64

    PDF, 247 KBLast Updated: 05/13/2025

    PDF, 247 KBLast Updated: 05/13/2025

  • Foot Orthotics Medicaid - Durable Medical Equipment 64

    PDF, 298 KBLast Updated: 05/13/2025

    PDF, 298 KBLast Updated: 05/13/2025

  • High Frequency Chest Wall Compression Commercial - Durable Medical Equipment 14

    PDF, 234 KBLast Updated: 05/13/2025

    PDF, 234 KBLast Updated: 05/13/2025

  • High Frequency Chest Wall Compression Medicaid - Durable Medical Equipment 14

    PDF, 269 KBLast Updated: 05/13/2025

    PDF, 269 KBLast Updated: 05/13/2025

  • Home Spirometry Commercial - Durable Medical Equipment 23

    PDF, 194 KBLast Updated: 05/13/2025

    PDF, 194 KBLast Updated: 05/13/2025

  • Home Spirometry Medicaid - Durable Medical Equipment 23

    PDF, 282 KBLast Updated: 05/13/2025

    PDF, 282 KBLast Updated: 05/13/2025

  • Home Traction Devices Commercial - Durable Medical Equipment 35

    PDF, 211 KBLast Updated: 05/15/2025

    PDF, 211 KBLast Updated: 05/15/2025

  • Home Traction Devices Medicaid - Durable Medical Equipment 35

    PDF, 256 KBLast Updated: 05/13/2025

    PDF, 256 KBLast Updated: 05/13/2025

  • Home Visual Field Monitoring Device Commercial - Durable Medical Equipment 62

    PDF, 190 KBLast Updated: 05/15/2025

    PDF, 190 KBLast Updated: 05/15/2025

  • Home Visual Field Monitoring Device Medicaid - Durable Medical Equipment 62

    PDF, 280 KBLast Updated: 05/13/2025

    PDF, 280 KBLast Updated: 05/13/2025

  • Home Visual Field Monitoring Device Medicare - Durable Medical Equipment 62

    PDF, 262 KBLast Updated: 05/13/2025

    PDF, 262 KBLast Updated: 05/13/2025

  • Hospital Beds and Accessories Commercial - Durable Medical Equipment 03

    PDF, 376 KBLast Updated: 06/04/2025

    PDF, 376 KBLast Updated: 06/04/2025

  • Hospital Beds and Accessories Medicaid - Durable Medical Equipment 03

    PDF, 427 KBLast Updated: 06/04/2025

    PDF, 427 KBLast Updated: 06/04/2025

  • Infant Home Apnea Monitor Commercial - Durable Medical Equipment 22

    PDF, 214 KBLast Updated: 05/13/2025

    PDF, 214 KBLast Updated: 05/13/2025

  • Infant Home Apnea Monitor Medicaid - Durable Medical Equipment 22

    PDF, 322 KBLast Updated: 05/13/2025

    PDF, 322 KBLast Updated: 05/13/2025

  • Intra-Oral Appliances and Splints for Temporomandibular Joint (TMJ) Syndrome Commercial - Durable Medical Equipment 222

    PDF, 275 KBLast Updated: 06/04/2025

    PDF, 275 KBLast Updated: 06/04/2025

  • Intra-Oral Appliances and Splints for Temporomandibular Joint (TMJ) Syndrome Medicaid - Durable Medical Equipment 222

    PDF, 273 KBLast Updated: 06/04/2025

    PDF, 273 KBLast Updated: 06/04/2025

  • Intra-Oral Appliances and Splints for Temporomandibular Joint (TMJ) Syndrome Medicare - Durable Medical Equipment 222

    PDF, 263 KBLast Updated: 06/04/2025

    PDF, 263 KBLast Updated: 06/04/2025

  • Iontophoresis Treatment for Hyperhidrosis Commercial - Durable Medical Equipment 32

    PDF, 209 KBLast Updated: 05/13/2025

    PDF, 209 KBLast Updated: 05/13/2025

  • Iontophoresis Treatment for Hyperhidrosis Medicaid - Durable Medical Equipment 32

    PDF, 259 KBLast Updated: 05/13/2025

    PDF, 259 KBLast Updated: 05/13/2025

  • Iontophoresis Treatment for Hyperhidrosis Medicare - Durable Medical Equipment 32

    PDF, 247 KBLast Updated: 05/13/2025

    PDF, 247 KBLast Updated: 05/13/2025

  • Jaw Motion Rehabilitation Systems Commercial - Durable Medical Equipment 43

    E1700, E1701, E1702

    PDF, 196 KBLast Updated: 05/13/2025

    E1700, E1701, E1702

    PDF, 196 KBLast Updated: 05/13/2025

  • Jaw Motion Rehabilitation Systems Medicaid - Durable Medical Equipment 43

    PDF, 249 KBLast Updated: 05/13/2025

    PDF, 249 KBLast Updated: 05/13/2025

  • Jaw Motion Rehabilitation Systems Medicare - Durable Medical Equipment 43

    PDF, 233 KBLast Updated: 05/15/2025

    PDF, 233 KBLast Updated: 05/15/2025

  • Low-Intensity Therapeutic Ultrasound (LITUS) Devices Commercial - Durable Medical Equipment 55

    PDF, 199 KBLast Updated: 05/13/2025

    PDF, 199 KBLast Updated: 05/13/2025

  • Low-Intensity Therapeutic Ultrasound (LITUS) Devices Medicaid - Durable Medical Equipment 55

    PDF, 277 KBLast Updated: 05/15/2025

    PDF, 277 KBLast Updated: 05/15/2025

  • Lymphedema Pump for Head and Neck Commercial - Durable Medical Equipment 245

    PDF, 196 KBLast Updated: 05/13/2025

    PDF, 196 KBLast Updated: 05/13/2025

  • Lymphedema Pump for Head and Neck Medicaid - Durable Medical Equipment 245

    PDF, 240 KBLast Updated: 05/13/2025

    PDF, 240 KBLast Updated: 05/13/2025

  • Mastectomy Garments Commercial - Durable Medical Equipment 240

    PDF, 204 KBLast Updated: 05/13/2025

    PDF, 204 KBLast Updated: 05/13/2025

  • Mastectomy Garments Medicaid - Durable Medical Equipment 240

    PDF, 256 KBLast Updated: 05/13/2025

    PDF, 256 KBLast Updated: 05/13/2025

  • Medical Car Seats Medicare - Durable Medical Equipment 58

    PDF, 224 KBLast Updated: 05/13/2025

    PDF, 224 KBLast Updated: 05/13/2025

  • Miscellaneous Assistive Devices for Home Use Commercial - Durable Medical Equipment 34

    PDF, 207 KBLast Updated: 05/15/2025

    PDF, 207 KBLast Updated: 05/15/2025

  • Miscellaneous Assistive Devices for Home Use Medicaid - Durable Medical Equipment 34

    PDF, 280 KBLast Updated: 05/13/2025

    PDF, 280 KBLast Updated: 05/13/2025

  • Miscellaneous Orthotics and Braces Commercial - Durable Medical Equipment 251

    PDF, 212 KBLast Updated: 05/14/2025

    PDF, 212 KBLast Updated: 05/14/2025

  • Miscellaneous Orthotics and Braces Medicaid - Durable Medical Equipment 251

    PDF, 296 KBLast Updated: 05/13/2025

    PDF, 296 KBLast Updated: 05/13/2025

  • Needleless Injection Commercial - Durable Medical Equipment 26

    PDF, 283 KBLast Updated: 05/15/2025

    PDF, 283 KBLast Updated: 05/15/2025

  • Needleless Injection Medicaid - Durable Medical Equipment 26

    PDF, 311 KBLast Updated: 05/15/2025

    PDF, 311 KBLast Updated: 05/15/2025

  • Negative Pressure Wound Vac Commercial - Durable Medical Equipment 241

    PDF, 259 KBLast Updated: 05/13/2025

    PDF, 259 KBLast Updated: 05/13/2025

  • Negative Pressure Wound Vac Medicaid - Durable Medical Equipment 241

    PDF, 309 KBLast Updated: 05/13/2025

    PDF, 309 KBLast Updated: 05/13/2025

  • Neuromuscular Electrical Stimulator and Functional Electrical Stimulators Commercial - Durable Medical Equipment 17

    PDF, 247 KBLast Updated: 05/13/2025

    PDF, 247 KBLast Updated: 05/13/2025

  • Neuromuscular Electrical Stimulator and Functional Electrical Stimulators Medicaid - Durable Medical Equipment 17

    PDF, 321 KBLast Updated: 05/15/2025

    PDF, 321 KBLast Updated: 05/15/2025

  • Obstructive Sleep Apnea Oral Devices Commercial - Durable Medical Equipment 250

    PDF, 0 bytesLast Updated: 05/15/2025

    PDF, 0 bytesLast Updated: 05/15/2025

  • Obstructive Sleep Apnea Oral Devices Medicaid - Durable Medical Equipment 250

    PDF, 235 KBLast Updated: 05/13/2025

    PDF, 235 KBLast Updated: 05/13/2025

  • Obstructive Sleep Apnea Oral Devices Medicare - Durable Medical Equipment 250

    PDF, 205 KBLast Updated: 05/13/2025

    PDF, 205 KBLast Updated: 05/13/2025

  • Pads with Circulating Liquid for Pain Relief Commercial - Durable Medical Equipment 242

    PDF, 190 KBLast Updated: 05/15/2025

    PDF, 190 KBLast Updated: 05/15/2025

  • Pads with Circulating Liquid for Pain Relief Medicaid - Durable Medical Equipment 242

    PDF, 241 KBLast Updated: 05/13/2025

    PDF, 241 KBLast Updated: 05/13/2025

  • Postural Support Seat Medicare - Durable Medical Equipment 56

    PDF, 228 KBLast Updated: 05/13/2025

    PDF, 228 KBLast Updated: 05/13/2025

  • Prosthetic Devices Commercial - Durable Medical Equipment 21

    PDF, 368 KBLast Updated: 05/13/2025

    PDF, 368 KBLast Updated: 05/13/2025

  • Prosthetic Devices Medicaid - Durable Medical Equipment 21

    PDF, 473 KBLast Updated: 05/15/2025

    PDF, 473 KBLast Updated: 05/15/2025

  • Scalp Cooling During Chemotherapy Commercial - Durable Medical Equipment 249

    PDF, 201 KBLast Updated: 05/13/2025

    PDF, 201 KBLast Updated: 05/13/2025

  • Scalp Cooling During Chemotherapy Medicaid - Durable Medical Equipment 249

    PDF, 251 KBLast Updated: 05/13/2025

    PDF, 251 KBLast Updated: 05/13/2025

  • Second (Back up) Ventilator Commercial - Durable Medical Equipment 51

    PDF, 287 KBLast Updated: 05/13/2025

    PDF, 287 KBLast Updated: 05/13/2025

  • Second (Back up) Ventilator Medicaid - Durable Medical Equipment 51

    PDF, 316 KBLast Updated: 05/14/2025

    PDF, 316 KBLast Updated: 05/14/2025

  • Specialized Supportive Seating and Medical Car Seats Commercial - Durable Medical Equipment 56

    PDF, 288 KBLast Updated: 05/15/2025

    PDF, 288 KBLast Updated: 05/15/2025

  • Specialized Supportive Seating and Medical Car Seats Medicaid - Durable Medical Equipment 56

    PDF, 311 KBLast Updated: 05/13/2025

    PDF, 311 KBLast Updated: 05/13/2025

  • Specialized Supportive Seating and Medical Car Seats Medicare - Durable Medical Equipment 56

    PDF, 280 KBLast Updated: 05/14/2025

    PDF, 280 KBLast Updated: 05/14/2025

  • Spinal Braces, Orthotics and Garments Commercial - Durable Medical Equipment 244

    PDF, 338 KBLast Updated: 05/13/2025

    PDF, 338 KBLast Updated: 05/13/2025

  • Spinal Braces, Orthotics and Garments Medicaid - Durable Medical Equipment 244

    PDF, 366 KBLast Updated: 05/13/2025

    PDF, 366 KBLast Updated: 05/13/2025

  • Standing Frames Commercial - Durable Medical Equipment 41

    PDF, 210 KBLast Updated: 05/13/2025

    PDF, 210 KBLast Updated: 05/13/2025

  • Standing Frames Medicaid - Durable Medical Equipment 41

    PDF, 293 KBLast Updated: 05/15/2025

    PDF, 293 KBLast Updated: 05/15/2025

  • Transfer Devices and Lifts Commercial - Durable Medical Equipment 42

    PDF, 226 KBLast Updated: 05/13/2025

    PDF, 226 KBLast Updated: 05/13/2025

  • Transfer Devices and Lifts Medicaid - Durable Medical Equipment 42

    PDF, 343 KBLast Updated: 05/13/2025

    PDF, 343 KBLast Updated: 05/13/2025

  • Ultraviolet Light Therapy System for Home Use Commercial - Durable Medical Equipment 60

    PDF, 265 KBLast Updated: 05/15/2025

    PDF, 265 KBLast Updated: 05/15/2025

  • Ultraviolet Light Therapy System for Home Use Medicaid - Durable Medical Equipment 60

    PDF, 317 KBLast Updated: 05/13/2025

    PDF, 317 KBLast Updated: 05/13/2025

  • Vertigo, Tinnitus, and Meniere’s Diagnosis Treatment Devices Commercial - Durable Medical Equipment 225

    PDF, 278 KBLast Updated: 05/13/2025

    PDF, 278 KBLast Updated: 05/13/2025

  • Vertigo, Tinnitus, and Meniere’s Diagnosis Treatment Devices Medicaid - Durable Medical Equipment 225

    PDF, 318 KBLast Updated: 05/13/2025

    PDF, 318 KBLast Updated: 05/13/2025

  • Vertigo, Tinnitus, and Meniere’s Diagnosis Treatment Devices Medicare - Durable Medical Equipment 225

    PDF, 288 KBLast Updated: 05/13/2025

    PDF, 288 KBLast Updated: 05/13/2025

  • Vitrectomy Face-Down Positioning System Commercial - Durable Medical Equipment 33

    PDF, 224 KBLast Updated: 05/13/2025

    PDF, 224 KBLast Updated: 05/13/2025

  • Vitrectomy Face-Down Positioning System Medicaid - Durable Medical Equipment 33

    PDF, 281 KBLast Updated: 05/13/2025

    PDF, 281 KBLast Updated: 05/13/2025

  • Wearable External Cardioverter Defibrillators Commercial - Durable Medical Equipment 24

    PDF, 312 KBLast Updated: 05/13/2025

    PDF, 312 KBLast Updated: 05/13/2025

  • Wearable External Cardioverter Defibrillators Medicaid - Durable Medical Equipment 24

    PDF, 358 KBLast Updated: 05/15/2025

    PDF, 358 KBLast Updated: 05/15/2025

  • Wheelchairs, Power Motorized Devices, Motorized Scooters and Accessories Commercial - Durable Medical Equipment 28

    PDF, 518 KBLast Updated: 06/05/2025

    PDF, 518 KBLast Updated: 06/05/2025

  • Wheelchairs, Power Motorized Devices, Motorized Scooters and Accessories Medicaid - Durable Medical Equipment 28

    PDF, 516 KBLast Updated: 06/05/2025

    PDF, 516 KBLast Updated: 06/05/2025

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© Sentara Health Plans 2025, PO Box 66189, Virginia Beach, Virginia 23466

Sentara Health Plans is the trade name for Sentara Health Plans, Sentara Health Insurance Company, Sentara Health Administration, Inc., and Sentara Behavioral Health Services, Inc. Vantage Health Maintenance Organization (HMO) and Point of Service (POS) plans are issued and underwritten by Sentara Health Plans. Medicare products are administered under an agreement with Sentara Health Plans and the Centers for Medicare and Medicaid Services (CMS). Medicaid and Family Access to Medical Insurance Security (FAMIS) products are administered under an agreement with Sentara Health Plans and the Virginia Department of Medical Assistance Services (DMAS). Plus Preferred Provider Organization (PPO) products are issued and underwritten by Sentara Health Insurance Company. The Sentara Employee Assistance Program (EAP) is administered by Sentara Behavioral Health Services, Inc. Large group self-funded health plans and BusinessEDGE® plans are administered but not underwritten by Sentara Health Administration, Inc. Wellness programs are administered by Sentara Health Administration, Inc. All plans have benefit exclusions and limitations, and terms under which the policy or plan may be continued in force or discontinued. For costs and complete details of coverage, please call your broker or review this website for more information. Sentara Health Plans complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.