The short answer
Equipment you need right away to stay stable or avoid further injury, like a splint, crutches, or a manual wheelchair, is covered under your existing Community Care authorization. Routine durable medical equipment, prosthetics, and orthotics need VA's approval first, through a Request for Service from your community provider.
Is medical equipment covered through Community Care?
Yes, but how depends on whether you need it right away. 38 CFR 17.4025(b) says VA pays for durable medical equipment (DME) and devices needed for urgent or emergent conditions, and fills prescriptions for DME and devices that aren't urgent.
What counts as urgent equipment?
Equipment you need immediately to stay stable or avoid further injury. The regulation gives splints, crutches, and manual wheelchairs as examples. VA's RFS page says urgent or emergent DME is covered under the existing authorization and can be provided without a separate Request for Service.
Implanted devices, like a joint replacement or a pacemaker, are covered under the authorization for the main condition.
Urgent care clinics can provide this kind of equipment too, under 38 CFR 17.4600.
What about routine equipment?
Routine DME, prosthetics, and orthotics need a Request for Service (RFS), VA Form 10-10172. Examples: a CPAP machine, a power wheelchair, a custom brace, a home hospital bed, or a prosthetic limb.
VA asks the community provider to submit the RFS within 24 hours, or by the next business day, after the visit that produced the prescription. The DME and prosthetics section of the form has its own page.
VA then decides how to provide the item. Often that's through VA's Prosthetic and Sensory Aids Service at your VA facility, which supplies most VA equipment.
What about rentals?
VA covers only the first 30 days of a DME rental under the authorization. For longer rentals, the provider needs to send an RFS before the 30 days run out so there's no gap.
What should I do if my community provider orders equipment?
- Ask whether it's urgent or routine. If it's urgent, it may be provided at the visit.
- For routine items, ask the provider to send the RFS right away, and ask for the date it went out.
- Call your VA Community Care office if you haven't heard anything within a few business days. VA says it processes requests within 3 business days.
- Don't buy it yourself and expect VA to pay you back. For routine items, wait for VA's approval.
Who repairs or replaces VA equipment?
Usually your VA facility's prosthetics department, even if a community provider ordered it. Ask your VA team for the prosthetics contact.
Do I pay for equipment?
You don't pay at the visit. VA's medical benefits package includes prosthetic and rehabilitative items, under 38 CFR 17.38. Ask your VA team whether any copay applies to your situation.