By the VerifyDoc team
Durable medical equipment charges are one of the most reliably error-prone lines on any medical bill — and the rental-vs.-purchase decision is the single biggest driver of those errors.
This post covers how Medicare's capped rental rules work under 42 CFR §§ 414.226 and 414.229, where suppliers commonly overcharge on timelines, maintenance fees, and ownership transfers, and what to look for on your Explanation of Benefits (EOB) or itemized bill before you pay a dollar.
Have your itemized bill handy? VerifyDoc reads it line by line and flags duplicates, upcoding, unbundling and math errors. The flag count is free; the full report, with a dispute letter for each finding, is $19.
Check my bill — free preview →Mistake #1: Assuming Rental Charges Can Continue Indefinitely
Many patients who receive a wheelchair, CPAP machine, or hospital bed assume that monthly rental charges will simply keep coming for as long as they use the equipment. That's wrong for most items covered by Medicare. Items in the capped rental category are paid on a monthly rental basis not to exceed a period of continuous use of 13 months. The rule governing this is 42 CFR § 414.229.
After 13 months of rental have been paid, the beneficiary owns the DME item, and after that time Medicare pays for reasonable and necessary maintenance and servicing of the item — parts and labor not covered by a supplier's or manufacturer's warranty. In plain terms: the supplier must hand over legal title to the equipment when month 13 ends. If you're still receiving a monthly rental invoice for the same item after that threshold, check your EOB immediately. That is a billing error worth disputing — and one the HHS Office of Inspector General has examined in its review of capped-rental DME claims (OEI-07-08-00550).
This cap applies to common items like manual wheelchairs, CPAP machines, and hospital beds. It does not apply to oxygen equipment, which has its own separate rental period described in Mistake #2. If you're unsure which category applies to your equipment, the guide to reading every line of your itemized hospital bill covers how to identify charge categories and match them to federal rules.
Mistake #2: Not Knowing the Oxygen Equipment Rule Is Different — and More Generous
Oxygen equipment operates under a different and longer rental structure. Payment for rental of oxygen equipment is made based on a monthly fee schedule amount during the period of medical need, but for no longer than a period of continuous use of 36 months , per 42 CFR § 414.226. During the first 36 months, Medicare pays your supplier a monthly rental fee, and that single payment covers everything: the equipment itself, all refills of oxygen tanks or cylinders if you use gaseous or liquid oxygen, all necessary supplies and accessories, and all maintenance and servicing.
Here's where patients get blindsided: after month 36, the rental payments stop — but the supplier's legal obligation does not. Under no circumstances can a beneficiary be charged for oxygen equipment furnished after the 36th paid rental month and before the end of the equipment's five-year reasonable useful lifetime. Per 42 CFR § 414.226(h)(1)(i), a supplier that received the 36th month rental payment must continue furnishing the oxygen equipment they were furnishing in month 36 during any period of medical need for the remainder of the equipment's five-year reasonable useful lifetime.
If you receive a rental charge for the oxygen equipment in months 37 through 60 of continuous use, that charge is not owed — provided you are still within the equipment's five-year useful life and your medical need continues. Oxygen contents are different: under § 414.226(a)(2) they are paid monthly for as long as medical need continues, with no 36-month limit, so your standard 20% Part B coinsurance on contents still applies. A separate maintenance and servicing fee is also payable every six months for concentrators and transfilling equipment after the cap (§ 414.210(e)(5)). Document the month your rental began, keep your EOB statements, and question any equipment rental charge that arrives after month 36.
Mistake #3: Paying for Maintenance on a Rented Item
A common overcharge pattern is a separate maintenance or "servicing" fee added to your bill while the equipment is still in its rental period. Under federal rules, this is generally not allowed. Payment is not made for maintenance and servicing of a rented item other than the maintenance and servicing fee for oxygen equipment or for other durable medical equipment as described in § 414.229(e). The oxygen exception applies after the 36-month rental cap has been reached. The second exception is historical: the § 414.229(e) fee applies only to items furnished before 2006 and still rented after 15 months, so it does not reach today's 13-month capped rentals under § 414.229(f).
For capped rental items under § 414.229 — wheelchairs, CPAP machines, hospital beds — the monthly rental payment is intended to be the all-in fee while the supplier holds title. Once you own the item (after the 13-month cap), Medicare may cover reasonable maintenance and repair: the carrier pays the reasonable and necessary charges for maintenance and servicing of beneficiary-owned equipment, meaning charges made for parts and labor not otherwise covered under a manufacturer's or supplier's warranty.
So the rule is straightforward: maintenance fees while renting = not billable. Maintenance fees after you own the equipment = potentially billable and covered by Medicare. If you see a line-item service fee during an active rental period, flag it. You can cross-reference charges against your EOB, which your insurer is required to send you. The post on what "adjustments" on a hospital bill really mean explains how to read those EOB line items and what offsets you should look for.
Mistake #4: Missing the Mandatory Purchase-Option Disclosure
Federal supplier standards require that you be told your options — but many patients never hear about them. Suppliers must advise beneficiaries of the purchase option for capped rental durable medical equipment, as defined in § 414.220(a). This obligation is codified in the DMEPOS Supplier Standards at 42 CFR § 424.57(c)(5).
More specifically, for capped rental items: the old requirement to offer a purchase option in the 10th month no longer applies. It survives in § 414.229(d) only for items furnished before January 1, 2006; items furnished since then fall under § 414.229(f), which contains no purchase option. Today a purchase option exists at the point the equipment is first furnished for complex rehabilitative power wheelchairs (§ 414.229(h)), and the tenth-month offer requirement remains only for parenteral and enteral nutrition pumps. For everything else in the capped-rental class, ownership transfers at the end of the 13-month period rather than being offered for sale part-way through.
The safeguard here is documentation. Make sure to ask if the supplier accepts assignment. Then get the answer in writing. If the answer is "no," the beneficiary should confirm in writing what the charges will be. A Medicare-enrolled supplier that does not accept assignment can charge without a prescribed limit, and the beneficiary is responsible for the difference between what Medicare will pay and what the supplier will charge. That difference can be substantial for high-cost power wheelchairs and complex rehabilitation equipment.
Mistake #5: Not Checking Whether the Equipment Was Ever Delivered
The DME sector is a frequent target for fraud, waste, and abuse. DME fraud can take many forms, including billing for equipment that is never delivered, providing unnecessary items, substituting billed equipment for an inferior product, or falsifying claims or documentation. According to HHS-OIG, fraudulent billing for DMEPOS costs taxpayers and the government millions of dollars each year.
For patients, the practical risk is that you may be billed — or Medicare may be billed on your behalf — for a piece of equipment you never received, or received in a form different from what was ordered. Scammers target Medicare enrollees through phone calls, internet ads, and text messages, and once they obtain the enrollee's personal information, monthly billing to Medicare will begin for medically unnecessary equipment that may or may not actually be sent to the enrollee.
Check your Medicare Summary Notice (MSN) or EOB every time a DME-related charge appears. If the description doesn't match equipment you actually have in your home, or if rental months are being billed for a period when you were hospitalized and the equipment wasn't in use, that is worth disputing. A step-by-step guide to phantom charges walks through how to dispute exactly these types of entries.
Quick Reference: DME Rental vs. Purchase — Key Rules at a Glance
The table below summarizes the federal payment structures for the most common DME categories. Use it to check whether the rental period on your bill is within the allowed range, and what happens at the end of each period. All amounts reflect Medicare fee schedule rules; your cost-sharing is 20% of the Medicare-approved amount after the Part B deductible.
| Equipment Category | Governing Rule | Rental Cap | What Happens at Cap | Maintenance After Cap |
|---|---|---|---|---|
| Capped rental items (wheelchairs, CPAP machines, hospital beds) |
42 CFR § 414.229 | 13 months continuous use | Ownership transfers to patient; no more rental payments | Medicare covers parts & labor not under warranty |
| Oxygen equipment (concentrators, tanks, portable units) |
42 CFR § 414.226 | 36 months continuous use | Supplier must continue furnishing at no charge through end of 5-year useful life | Supplier provides servicing; limited maintenance payments after month 36 |
| Power wheelchairs (complex rehab) |
42 CFR § 414.229(b), (f) | 13 months; different monthly % of purchase price | Ownership transfers; can also be purchased outright | Medicare covers reasonable maintenance & servicing |
| Inexpensive / routinely purchased items (blood glucose monitors, canes) |
42 CFR § 414.220 | Total payments capped at the purchase fee schedule amount (§ 414.220(b)(3)); purchase option available from day one | N/A — generally purchased outright | Not separately covered |
| Parenteral/enteral pumps | CMS IOM Pub. 100-04, Ch. 20 §30.7.1 | Can be rented or purchased at beneficiary's election | Depends on rental or purchase election | Covered if purchased |
Sources: 42 CFR Part 414 Subpart D (eCFR, updated through Aug. 13, 2026); CMS Internet Only Manual, Pub. 100-04, Chapter 20.
Decision Tree: Should You Dispute a DME Charge?
Use this decision tree when a DME rental or purchase charge appears on your bill or EOB and something looks off. Work top to bottom.
How to Actually Check Your DME Bill: A Worked Example
(The following is an illustrative example using fictional patient details. It is not drawn from a real patient record.)
Suppose a patient — call her M.L. — rented a standard manual wheelchair starting March 1, 2025. She receives a monthly invoice and EOB each month showing a rental charge for HCPCS code K0001 (standard manual wheelchair). By April 2026, month 14, she's still receiving a rental invoice. Under 42 CFR § 414.229, rental payments for capped-rental items may not exceed 13 continuous months. Month 14 is outside that window — title should have transferred to her at the start of month 14.
Her next step: pull her EOB for all 14 months, confirm the "from" date on each claim, and contact the DME supplier in writing requesting written confirmation that title has transferred. If the supplier insists the charge is valid, she can file a Medicare claim dispute through her Medicare Administrative Contractor (MAC) and, if necessary, request a formal redetermination. The Medical Billing Error Checker guide explains how to systematically document errors before filing a dispute.
She should also check whether the billed item matches what she has. DME fraud can take many forms, including billing for equipment that is never delivered or substituting billed equipment for an inferior product. If the HCPCS code on her bill corresponds to a more expensive item than the chair she actually received, that's a potential upcoding issue — something covered in depth in our post on how hospitals inflate bills through upcoding.
About VerifyDoc: We help patients identify errors and overcharges on medical bills. We publish guides on hospital billing, the No Surprises Act, and disputing medical charges, updated as federal and state rules change.
Think your bill has errors? Check it in seconds.
Upload your itemized bill and VerifyDoc decodes every line and flags likely errors — duplicates, upcoding, unbundling, phantom charges, and math errors. The flag count is free. The full line-by-line report and a dispute letter for each finding are $19, one flat fee.
Check my bill — free preview →Frequently asked questions
How do I know if my DME item is in the "capped rental" category or the "inexpensive/routinely purchased" category?
The distinction is made by CMS based on the item's typical cost and usage pattern. Capped rental is the residual category: items that fall into none of the other DME payment classes — wheelchairs, CPAP machines and hospital beds among them — rented month-to-month under 42 CFR § 414.229, with rental payments capped at 13 months. Inexpensive or routinely purchased items, like blood glucose monitors or canes, are generally purchased outright because their cost is low relative to ongoing rental. Your DME supplier is required under 42 CFR § 424.57(c)(5) to advise you of both the rental and purchase options before you commit. If you're unsure which category applies, ask your supplier for the HCPCS code for your equipment, then search that code in the CMS DMEPOS fee schedule database to see how it's classified.
My oxygen supplier is telling me I owe a monthly rental fee after month 36. Is that allowed?
No. Under 42 CFR § 414.226 and Section 1834(a)(5)(F)(ii)(I) of the Social Security Act, a supplier that received the 36th month rental payment must continue furnishing your oxygen equipment during any period of medical need for the remainder of the equipment's five-year reasonable useful lifetime, at no additional charge. The only costs you should still be paying after month 36 are your standard Medicare Part B coinsurance (20%) on the oxygen contents themselves, not on the equipment rental. If your supplier is billing a rental fee after month 36, that is a violation of federal regulations — document the charge and contact your Medicare Administrative Contractor to have it corrected.
Can a DME supplier charge me more than the Medicare-approved amount?
It depends on whether the supplier accepts Medicare assignment. A Medicare-enrolled supplier that accepts assignment is bound by the Medicare fee schedule. However, a supplier that does not accept assignment is not subject to the same limiting charge rules that apply to physicians — meaning they can charge above the Medicare-approved amount, and you are responsible for the difference. This is a significant risk for high-cost items like power wheelchairs and complex respiratory equipment. Always ask in writing whether a supplier accepts assignment before agreeing to rent or purchase. If they don't, get a written estimate of your total out-of-pocket cost before you take delivery.
What should I do if I find a rental charge on my EOB for equipment I returned or that broke down?
Under 42 CFR § 414.229, a capped rental item may not be replaced by the supplier prior to the expiration of the 13-month rental period unless specific conditions are met, such as the item being lost, stolen, or irreparably damaged. If you returned equipment because you no longer needed it or because it broke down, rental charges should stop with the billing month in which use ceased. Pull your delivery and return records, compare dates against the EOB, and dispute any month where the claim date of service falls after you stopped using the equipment. Contact your Medicare Administrative Contractor to initiate a formal redetermination if the supplier disputes your claim.