The short answer
CHAMPVA covers durable medical equipment (DME), like wheelchairs, oxygen, and hospital beds, when it's medically necessary, ordered by a physician, and used at home for a medical purpose. Some items need extra paperwork, like a certificate of medical necessity. It doesn't cover home changes like ramps or elevators, air conditioners, or exercise equipment. No preauthorization is needed.
What counts as DME?
The CHAMPVA Guidebook says DME is equipment that:
- holds up to repeated use,
- is mainly for a medical purpose,
- generally isn't useful to someone without an illness or injury, and
- is appropriate for use at home.
CHAMPVA can also cover accessories, customization, maintenance, repairs, and replacement because of wear or a change in your condition.
It has to be ordered by a physician. But under 38 CFR 17.272, an order alone doesn't prove medical necessity.
What paperwork do some items need?
The Guidebook gives examples:
| Item | What the claim needs |
|---|---|
| Oxygen | A certificate of medical necessity (CMN) with flow rate, how often and how long, expected length of need, and delivery method |
| Power wheelchair or scooter | A CMN or doctor's order with diagnosis, a seating evaluation, and proof it can be used inside the home |
| TENS unit or neurostimulator | A CMN or doctor's order with diagnosis |
| Wound vac | A CMN or order, wound measurements, start date, and expected length of need |
| Patient lift | A CMN plus records showing you can't get out of bed and have no caregiver who can move you |
For oxygen with a lifetime need, the Guidebook says you don't need a new prescription with every bill.
What isn't covered?
38 CFR 17.272 excludes:
- exercise equipment, hot tubs, pools, and whirlpools,
- air conditioners, humidifiers, dehumidifiers, and air purifiers,
- elevators,
- changes to your home, like ramps or wider doors, even if needed to use covered equipment, and
- personal comfort or convenience items.
A prescription doesn't change that.
Does DME need preauthorization?
No. DME isn't on CHAMPVA's preauthorization list in 38 CFR 17.273. For expensive items, have the supplier confirm the paperwork before delivery.
How is DME priced and what do you pay?
Under 38 CFR 17.275, CHAMPVA uses Medicare's equipment fee schedule for your area. When CHAMPVA is your only coverage, you pay your yearly deductible, then 25% of the allowable amount.
Ask if the supplier accepts CHAMPVA assignment. If not, you may pay upfront and owe more than CHAMPVA's price. More here: CHAMPVA assignment and balance billing.
Before delivery
- Make sure the diagnosis explains why you need it.
- Confirm it isn't an excluded item.
- Get the physician's order on file.
- Complete any item-specific paperwork.
- Tell the supplier about other insurance.
- Ask about assignment and what you'll owe.
- Ask the supplier to bill CHAMPVA under payer ID 84146.
If it's denied
Check whether it was missing paperwork, an excluded item, other insurance, or a billing issue. Send what's missing, or use the review options in the letter. More here: CHAMPVA claim denials.