Medicare Part B covers essential durable medical equipment like wheelchairs, hospital beds, and oxygen systems for eligible beneficiaries. But the rules around replacing these items are strict. In most cases, Medicare only pays for a replacement after five years its “Reasonable Useful Lifetime” (RUL) unless rare exceptions apply.
Here’s what patients and providers need to know to navigate these rules effectively.
What Is Medicare’s 5-Year Replacement Rule (RUL)?
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Medicare begins counting from the delivery date of a piece of equipment to the beneficiary.
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Until the five-year period ends, Medicare generally pays for repairs, not replacements unless the item is lost, stolen, or irreparably damaged.
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Once the RUL has passed, a replacement may be allowed provided medical necessity and documentation requirements are met.
Repair vs. Replacement: What Medicare Covers
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Within the 5-year period: Only repairs are covered if it’s reasonable and necessary. If the item cannot be reasonably repaired, a replacement may be considered even before five years.
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After five years (RUL expired): A replacement is generally approved if:
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The equipment is no longer serviceable.
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A new physician’s order (or Standard Written Order) documents continued medical need.
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A Medicare-enrolled supplier processes the claim.
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When Replacement May Be Denied
Replacement isn’t guaranteed after five years if the device still functions:
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If the equipment remains safe, serviceable, and medically necessary even beyond its RUL Medicare typically denies replacement.
Early Replacement: When It’s Allowed
Medicare may cover replacement before five years in these scenarios:
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Loss or theft of the DME (with documentation, such as a police report).
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Irreparable damage due to accidents or disasters.
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Repair is not reasonable, meaning repair costs are equal to or exceed the cost of a comparable replacement.
What Documentation Is Needed?
To request a replacement whether after five years or early these documents are critical:
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A new physician’s order or Standard Written Order stating ongoing medical necessity.
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Supplier notes or provider documentation explaining why repair isn’t reasonable or why a replacement is necessary.
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If applicable, documents like a police report, insurance claim, or detailed damage statement.
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The supplier must be Medicare-enrolled ideally one that accepts assignment.
Real-Life Examples
| Scenario | Situation | Result |
|---|---|---|
| After 5 years, worn out | Manual wheelchair is six years old, worn, and unsafe. | Replacement approved with documentation. |
| After 5 years, working fine | Six-year-old walker is still stable and usable. | Replacement denied because it remains serviceable. |
| Before 5 years, repair cost too high | Wheelchair frame cracked, repair ≈ $700, new ≈ $600. | Replacement approved because repair isn’t cost-effective. |
Why This Rule Exists
Medicare’s 5-year replacement policy isn’t arbitrary—it’s based on balancing patient needs, healthcare budgets, and sustainability. The main goals include:
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Cost-control: Ensures Medicare funds are used efficiently, covering replacement only when devices are genuinely worn out, damaged beyond repair, or medically outdated. This prevents unnecessary spending that could raise overall program costs.
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Equipment longevity: Encourages beneficiaries to use their medical devices for the entirety of their Reasonable Useful Lifetime (RUL), promoting regular maintenance and responsible care.
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Preventing waste: Limits unnecessary upgrades or replacements, reducing the environmental impact from disposing of still-functional equipment.
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Fraud prevention: Discourages suppliers from prematurely replacing equipment to bill Medicare for higher profits, a practice that has historically contributed to fraud and abuse in the DME sector.
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Resource prioritization: Ensures limited Medicare funds are available for beneficiaries with urgent needs, rather than being consumed by avoidable replacements.
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Consistency in coverage: Establishes a clear national standard so that replacement decisions aren’t based on subjective judgments or varying supplier policies this promotes fairness and uniformity across the program.
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Encouraging proper documentation: By requiring proof of continued medical necessity and condition of equipment, the policy strengthens recordkeeping, which supports both compliance and patient safety.
What About Oxygen Equipment?
Oxygen systems such as concentrators, portable oxygen tanks, and related accessories are treated differently under Medicare’s DME replacement rules because they operate under a rental-based reimbursement model.
1. Initial Rental Period (36 Months)
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Medicare covers monthly rental payments for the first 36 months of oxygen equipment use.
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During this time, the supplier owns the equipment and is responsible for all maintenance, servicing, and necessary accessories.
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The beneficiary pays only their standard 20% coinsurance and any unmet Part B deductible.
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At the end of the rental period, ownership does not transfer to the patient—the supplier continues to provide the same equipment.
2. Supplier Maintenance Obligation (Months 37–60)
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After the initial 36 months, the supplier must continue providing:
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Oxygen refills (if applicable).
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Replacement accessories such as tubing, nasal cannulas, or masks.
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Repairs and servicing to ensure safe, functional operation.
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This maintenance is provided at no extra cost to the beneficiary for the remainder of the 5-year Reasonable Useful Lifetime (RUL).
3. Replacement After 5 Years
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Once the 5-year RUL is complete, beneficiaries may:
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Select a new Medicare-approved supplier.
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Begin a new 36-month rental period with fresh equipment.
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A new physician’s order confirming the continued medical need for oxygen therapy is required.
4. Early Replacement Exceptions for Oxygen Equipment
Although oxygen systems have their own structured cycle, early replacement may be approved if:
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The equipment is irreparably damaged (e.g., from a fire or natural disaster).
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The system is lost or stolen.
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Repair costs exceed replacement costs.
5. Why the Oxygen Rules Are Different
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Oxygen therapy is life-sustaining and must be available without interruption, which is why Medicare ensures continuous supplier responsibility during the RUL.
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The rental model spreads costs over time, reducing upfront expense and ensuring ongoing maintenance.
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These rules also prevent patients from being left with unsafe or outdated oxygen devices.
Velatrixa: Your Medicare DME Replacement Partner
Medicare’s 5-year DME replacement rules can be confusing but Velatrixa makes them simple. We handle the paperwork, ensure compliance, and submit complete, accurate claims to minimize denials and delays. From early replacements to oxygen equipment coverage, our team helps providers and patients get the equipment they need fast and stress-free.
Contact Velatrixa today to simplify your Medicare DME billing and replacement process.