The letter you have
Wheelchair, CPAP, oxygen, prosthetic, insulin pump, hospital bed. Most DME denials are missing paperwork — not a finding that you don’t qualify.
At stake: $3,000 – $100,000+
Health & Medical
You found the right place.
Your Durable Medical Equipment Was Denied. Here's How to Appeal.
What we do with it
We read the letter. We explain it in plain English. In about 30 seconds you’ll know where you stand — and what to do next.
No account needed · Results in about 30 seconds · Free to start
CMS Local Coverage Determinations — the Rules Insurers Must Follow
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.
What Does a High Viability Score Mean?
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.
90–100Documentation gap only — correctable with physician update
70–89Solid case — LCD criteria met with additional documentation
50–69Possible — depends on functional assessment and clinical specifics
Three Common DME Denials — and Why They Are Overturnable
These are the situations we see most often. Every one comes down to documentation — and documentation can be fixed.
Power Wheelchair & Mobility
82
Viability
Medicare or private insurance denied a power wheelchair, power scooter, or manual wheelchair as "not medically necessary."
"Your request for a power operated vehicle has been denied. The documentation submitted does not support that you have a mobility limitation requiring a power wheelchair for use in your home."
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.
CPAP & Sleep Equipment
80
Viability
CPAP machine, mask supplies, or oxygen equipment was denied — often after initial approval lapsed or during a coverage review.
"Coverage for continuous positive airway pressure equipment has been denied. The required compliance documentation and updated physician order have not been received within the required timeframe."
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.
Prosthetics & Orthotics
78
Viability
A prosthetic limb, orthotic device, or custom brace was denied as not medically necessary or as exceeding coverage limits.
"Your request for a lower extremity prosthesis has been denied. The functional classification level documented does not support the prosthetic foot category requested."
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.
Here's How It Works — Three Simple Steps
From denial letter to appeal-ready in about 3 minutes. We know the documentation requirements — so you don't have to.
1
Upload Whatever You Received
Take a photo or upload a PDF — that's really all it takes.
2
We Read It and Explain It
Within seconds — the specific LCD identified, the documentation gap found.
3
Your Complete Appeal Letter Is Ready
CMS criteria cited, documentation gaps addressed, ready to send — for $39.
How to appeal a DME denial — start free
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.
Start My Free Analysis →Free to analyze · $39 complete appeal · No subscription · All escalation levels included