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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 under the circumstances specified below, payment may be made for repair, maintenance, and 
replacement of medically required DME, including equipment which had been in use before the user enrolled 
in Part B of the program. However, do not pay for repair, maintenance, or replacement of equipment in the 
frequent and substantial servicing or oxygen equipment payment categories. In addition, payments for repair 
and maintenance may not include payment for parts and labor covered under a manufacturers or suppliers 
warranty. 
 
A. Repairs 
To repair means to fix or mend and to put the equipment back in good condition after damage or wear. Repairs 
to equipment which a beneficiary owns are covered when necessary to make the equipment serviceable. 
However, do not pay for repair of previously denied equipment or equipment in the frequent and substantial 
servicing or oxygen equipment payment categories. If the expense for repairs exceeds the estimated expense of 
purchasing or renting another item of equipment for the remaining period of medical need, no payment can be 
made for the amount of the excess. (See subsection C where claims for repairs suggest malicious damage or 
culpable neglect.) 
 
C. Replacement 
 
Replacement refers to the provision of an identical or nearly identical item. Situations involving the provision 
of a different item because of a change in medical condition are not addressed in this section. 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 physicians 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. If the item of equipment has been in continuous use by the patient on either a rental 
or purchase basis for the equipments useful lifetime, the beneficiary may elect to obtain a new piece of equipment. Replacement 
may be reimbursed when a new physician order and/or new CMN, when required, is needed to reaffirm the 
medical necessity of the item. 
 
The reasonable useful lifetime of durable medical equipment is determined through program instructions. In the 
absence of program instructions, A/B MACS (B) may determine the reasonable useful lifetime of equipment, 
but in no case can it be less than 5 years. Computation of the useful lifetime is based on when the equipment is 
delivered to the beneficiary, not the age of the equipment. Replacement due to wear is not covered during the 
reasonable useful lifetime of the equipment. During the reasonable useful lifetime, Medicare does cover repair 
up to the cost of replacement (but not actual replacement) for medically necessary equipment owned by the 
beneficiary. (See subsection A.) 
 
You can find this information in the Medicare Benefit Policy Manual Chapter 15  Covered Medical and Other 
Health Services, Section 110.2 - Repairs, Maintenance, Replacement, and Delivery. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.