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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that replacement refers to the provision of an identical or nearly identical item. Equipment which 
the beneficiary owns or is a capped rental item may be replaced in cases of loss or irreparable damage. 
Irreparable damage refers to a specific accident or to a natural disaster (e.g., fire, flood).  A physician's order 
and/or new Certificate of Medical Necessity (CMN), when required, is needed to reaffirm the medical necessity 
of the item. Irreparable wear refers to deterioration sustained from day-to-day usage over time and a specific 
event cannot be identified.  Replacement of equipment due to irreparable wear takes into consideration the 
reasonable useful lifetime of the equipment. You can find this rule in the Medicare Benefit Policy Manual, 
Chapter 15, Section 100.2. 
  
The rules say that the reasonable useful lifetime of durable medical equipment is determined through program 
instructions. In the absence of program instructions, A/B MACs may determine the reasonable useful lifetime 
of equipment, but in no case can it be less than five years. You can find this rule in the Medicare Benefit Policy 
Manual, Chapter 15, Section 100.2. 
 
The rules say that reimbursement for oxygen equipment is limited to 36 monthly rental payments. Payment for 
accessories (e.g., cannula, tubing, etc.), delivery, back-up equipment, maintenance, and repairs is included in 
the rental allowance. Payment for oxygen contents (stationary and/or portable) is included in the allowance for 
stationary equipment (E0424, E0439, E1390, E1391).  The supplier who provides oxygen equipment for the 
first month must continue to provide any necessary oxygen equipment and all related items and services 
through the 36-month rental period. You can find this rule in Local Coverage Article: Oxygen and Oxygen 
Equipment - Policy Article (A52514) - Effective August 2, 2020. 
 
The rules say there is no further payment for oxygen equipment during the 5-year reasonable useful lifetime 
(RUL) of the equipment after 36 rental payments have been made. If use of portable equipment (E0431, E0433, 
E0434, E1392, K0738) begins after the use of stationary equipment begins, payment for the portable equipment 
can continue after payment for the stationary equipment ends until 36 rental payments have been made for the 
portable equipment.  The supplier who provided the equipment during the 36th rental month is required to 
continue to provide the equipment, accessories, contents (if applicable), maintenance, and repair of the oxygen 
equipment during the 5 year reasonable useful lifetime of the equipment. You can find this rule in Local 
Coverage Article: Oxygen and Oxygen Equipment - Policy Article (A52514) - Effective August 2, 2020. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.