Chapter 14 Durable Medical Equipment (DME)

Durable Medical Equipment (DME)Other InformationAdded: Priorauthorizationsfor rental…ofthe ACDdevice.TopicInvoiceTrial PeriodRepairLoss/DamageComponent /Accessory LimitsWheelchairsRequired for the PAThe prior authorization request and the manufacturer’s invoice mustbe forwarded to EDS Prior Authorization department.No communication components will be approved unless the clienthas used the equipment and demonstrated an ability to use theequipment.Prior authorization for rental may be obtained for a trial period. Thisdemonstrated ability can be documented through periodic use ofsample/demonstration equipment. Adequate supportingdocumentation must accompany the request.Prior authorizations for rental of ACD device E2510 may be approvedfor a four (4) week trial period of usage by the recipient. Themanufacturer must agree to this trial period. Medicaid will reimbursethe manufacturer for the dollar amount authorized by the Agency forthe four (4) week trial period. This amount will be deducted from thetotal purchase price of the ACD device.Repairs are covered only to the extent not covered by manufacturers’warranty. Repairs must be prior approved. Battery replacement is notconsidered repair and does not require prior authorization.Replacement of identical components due to loss or damage must beprior approved. These requests will be considered only if the loss ordamage is not the result of misuse, neglect, or malicious acts by theusers.No components or accessories will be approved that are notmedically required. Examples of non-covered items include but arenot limited to the following:• Printers• Modems• Service contracts• Office/business software• Software intended for academic purposes• Workstations• Any accessory that is not medically required.To qualify for Medicaid reimbursement of a wheelchair, 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:Deleted: to Section 14.5.3Added: Appendix PDeleted: Effective October1, 2000, beganreimbursingAdded: reimbursesDeleted: Medicare’sprocedure codeAdded: HCPC code• The recipient must be essentially chair confined or bed/chair confined.• The wheelchair is expected to increase mobility and independence.A standard wheelchair (procedure code E1130) should be requested unlessdocumentation supports the need for any variation from the standard wheelchair. Anexample of this variation is an obese recipient who requires the wide heavy-dutywheelchair (E1093). For a list of valid wheelchair procedure codes, refer Appendix P,Procedure Codes and Modifiers.Medicaid reimburses Durable Medical Equipment providers for Extra Heavy DutyWheelchairs. These wheelchairs accommodate weight capacities up to 600 lbs.Medicaid covers these wheelchairs as a purchase by using HCPC code K0007.14-18 April 2005