Wheelchairs, CPAP machines, oxygen, prosthetics, orthotics, insulin pumps, hospital beds — Medicare and private insurers deny durable medical equipment at alarming rates. Most denials result from documentation gaps, not genuine ineligibility. You have the right to appeal every one.
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Medicare uses Local Coverage Determinations (LCDs) published by Medicare Administrative Contractors to define exactly what documentation is required for each type of durable medical equipment. Every DME denial must reference a specific LCD — and if the denial was based on missing documentation rather than true ineligibility, that documentation can be provided on appeal. Most patients who lose DME appeals lose because of documentation gaps, not because they don't qualify.
These are the situations we see most often. Every one comes down to documentation — and documentation can be fixed.
Why it overturns: Power wheelchair denials under Medicare almost always involve either the face-to-face examination requirement or the mobility examination documentation. The LCD for power mobility devices requires a face-to-face clinical evaluation by a physician, NP, PA, or clinical nurse specialist that specifically documents in-home mobility limitations using the Medicare mobility criteria. If this examination occurred but was not properly documented in the notes, the documentation can be corrected and resubmitted. Your physician must document that you cannot perform MRADLs (Mobility Related Activities of Daily Living) in your home without the requested device.
Why it overturns: CPAP denials almost always fall into one of two categories: initial authorization denials due to sleep study documentation issues, or compliance-related denials after 91 days of use. For initial denials, the sleep study must document an AHI (Apnea-Hypopnea Index) meeting Medicare's threshold, and the treating physician must document that CPAP is ordered and medically necessary. For compliance denials, the usage data from the CPAP device must demonstrate the required usage hours — if the data was not submitted to the insurer, this is an administrative issue rather than a coverage issue and can be corrected with a resubmission.
Why it overturns: Prosthetic denials frequently involve functional classification errors — Medicare rates amputees on a K-level scale (K0 through K4) based on rehabilitation potential. Denials often occur when the insurer assigns a lower K-level than the patient's documented function warrants, or when the physician's functional assessment was completed before rehabilitation was complete and no longer reflects current capabilities. An updated functional assessment by a physiatrist or physical therapist documenting the patient's actual functional level and the prosthetic components required to meet that level is the most powerful evidence on appeal.
From denial letter to appeal-ready in about 3 minutes. We know the documentation requirements — so you don't have to.
Take a photo or upload a PDF — that's really all it takes.
Medicare denial letter, private insurance DME rejection, prior authorization denial, coverage termination notice for ongoing equipment — if it is official, confusing, and standing between you or a loved one and necessary medical equipment, ClaimCompass can read it. Your document is handled securely and deleted if you do not continue. No account needed.
Within seconds — the specific LCD identified, the documentation gap found.
Our AI identifies the specific Local Coverage Determination that applies to your equipment, what documentation requirement caused the denial, and whether the denial was a genuine disqualification or a correctable documentation issue. You receive a viability score from 0–100, an explanation of exactly what went wrong, and a specific list of what your physician needs to document to overturn the denial. Completely free, no sign-up required.
CMS criteria cited, documentation gaps addressed, ready to send — for $49.
ClaimCompass generates a complete appeal letter citing the specific LCD criteria that apply to your equipment, addressing the documentation gap identified in the denial, and specifying what your physician must document to establish coverage. The letter follows CMS-mandated appeal procedures and timelines. Level 1 appeal, Level 2 escalation, and ALJ hearing request letters are all included in your single $49 payment. No subscription, no additional charge if denied again.
A score above 70 means you have a solid case worth pursuing. A score of 90 or higher — which we see frequently when the denial was caused by a documentation gap rather than true ineligibility — means the denial can be overturned with the right physician documentation.
Upload your DME denial. In under a minute, you'll know whether the denial was a documentation gap — and exactly what your physician needs to document to overturn it.
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