Chapter 14 Durable Medical Equipment (DME)

Durable Medical Equipment (DME) 14Trapeze Bar, AKA Recipient Helper, Attached to Bed with Grab Bar(E0910)To qualify for Medicaid reimbursement of a trapeze bar, the physician must prescribethe equipment as medically necessary for the recipient. Request for coverage must bereceived by EDS within thirty calendar days after the date that the equipment wasdispensed. The recipient must be essentially bed confined and must meet the followingdocumented conditions:• The recipient must have positioning problems. Documentation must show that therecipient has physical/mental capability of using the equipment for repositioning.• The recipient must have difficulty getting in and out of bed independently.This equipment may be purchased for any qualified Medicaid recipient who meets theabove criteria. This equipment may also be rented for any recipient under the age of 21who is referred under the EPSDT program. The information submitted must includedocumentation that the recipient meets the above medical criteria.NOTE:Purchase of the trapeze bar is limited to one per lifetime for recipients who meetthe above criteria.Nebulizer (E0570)The nebulizer is a covered service in the DME program for all recipients. The nebulizercan be provided only if it can be used properly and safely in the home. A physicianmust prescribe it as medically necessary.This equipment may be purchased for any qualified Medicaid recipient based on thecriteria listed below. This equipment may also be rented for any recipient under the ageof 21 who is referred through the EPSDT Program.The policy limiting purchase of a nebulizer (E0570) to one every two years was revised.One nebulizer may be purchased every four years for recipients if medcially necessary.Medicaid system changes were made to ensure that nebulizer purchases subject to thelimitation of one every two years has an end date of December 31, 2002 andpurchases subject to the limitation of one every four years has a begin date of January1, 2003. The system looks at claims from previous years as well as current history toensure that claims paid in 2002 will not be paid again until the four years are up.The prior authorization requirement for neulizers was dropped in June 1999,therefore, nebulizers do not require prior authorization and should not besubmitted to EDS for prior authorization.Request for consideration of payment for replacement of nebulizers due to theft or lossby disasters must be submitted with a police or fire report and a clean claim to theAlabama Medicaid Agency, 501 Dexter Avenue, Long Term Care Division,Montgomery, AL, 36103.April 2005 14-11