Chapter 14 Durable Medical Equipment (DME)

Durable Medical Equipment (DME) 14• The recipient must be essentially bed confined.• The recipient’s physician must supervise the use of the APP in connection with thecourse of treatment.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 through the EPSDT Program. The information submitted must includedocumentation that the recipient meets the above medical criteria.NOTE:Alternating pressure pads are limited to one every three years for recipients whomeet the above criteria.Gel or Gel-like Pressure Pad for Mattress (E0185)Gel or gel-like pressure pads will be considered for Medicaid payment when prescribedas medically necessary by a physician. Request for coverage must be received by EDSwithin thirty calendar days after the date that the equipment was dispensed. Aneligible recipient must meet the following medical criteria:• Documentation must indicate the recipient has, or is highly susceptible to decubitusulcers.• The recipient must be essentially bed confined.• The recipient’s physician must supervise the use of the gel or gel-like pressure padin connection with the course of treatment.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 through the EPSDT Program. The information submitted must includedocumentation that the recipient meets the above medical criteria.NOTE:Purchase of the gel or gel-like pressure pad is limited to one every two years forrecipients who meet the above criteria.Mattress Replacement (E0271)To qualify for Medicaid reimbursement of a mattress replacement, a physician mustprescribe the equipment as medically necessary. Request for coverage must bereceived by EDS within thirty calendar days after the date that the equipment wasdispensed. An eligible recipient must meet the following medical criteria:• The patient has a safe and adequate hospital bed in his home• Documentation must be submitted showing the mattress in use is damaged andinadequate to meet the patient’s medical needs.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 through the EPSDT Program. The information submitted must includedocumentation that the recipient meets the above medical criteria.April 2005 14-9