If your client is covered by a managed care organization such as:
- Amerigroup
- Community Health Plan of Washington (CHPW)
- Coordinated Care of WA
- Molina Healthcare
- United Healthcare (UHC)
Contact the plan directly for program benefits.
Provider guides
- Complex Rehabilitation Technology (CRT)
- Durable Medical Equipment (DME) and Noncomplex Rehabilitation Technology (CRT) wheelchairs
- Enteral nutrition
- How to obtain nonsterile gloves for your personal caregivers
- Medical supplies and equipment fee schedule
- Nondurable Medical Supplies and Equipment (MSE)
- Includes information about diabetic testing supplies, incontinence supplies, braces, etc.
- Prosthetic and orthotic devices
- Respiratory care
Limitation extension
WAC 182-501-0169 allows clients receiving any of these services to request an exception to the limits if their health care needs are not being met.
Did you know?
You can contact the client's case worker to get assistance with the required documentation. You can do this at any time during the DME authorization process.
Patient specific information must be sent via secure email to protect patient privacy and comply with HIPAA regulations.
When sending emails, we suggest the following subject lines to help expedite response time.
- Expedite for D/C (discharge within one week)
- Expedite: client safety concerns
- Rates Request (the rate does not cover the cost of the item)
- Limitation extension
- When Medicare is primary payer, but client does not meet Medicare medically necessary criteria, enter "Does not meet Medicare MN criteria"
Resources
- DME provider webinar presentation
- Diabetes supplies (limitation extension request)
- Bathroom equipment (limitation exception to rule)
- Compression garments (limitation exception to rule)
- Incontinent supplies (limitation extension request)
- Enteral nutrition (exception to rule)
- Fee-for-service providers of nonsterile gloves
- General information for authorization (13-835)
Social service authorizations
- Client responsibility
- Vendor bathroom equipment flow chart
- Vendor lift chair flow chart
- Vendor information specialized equipment and supplies (SA421)
Durable Medical Equipment (DME)
Medicaid Durable Medical Equipment Supplies and Listing, Updates and Training
Overview
The following listing, based upon the Healthcare Common Procedure Coding System (HCPCS), describes equipment and supplies, coverage limitations, and service authorization (SA) requirements. The DME Listing HCPCS codes must be used for all Medicaid claims, regardless of whether Medicare uses the same HCPCS code for the item. Service authorization by Medicaid is not required when Medicare is the primary payer. Reimbursement for Medicare crossover claims will be made in accordance with established Medicare HCPCS codes and guidelines.
Appendix B
Medicaid Durable Medical Equipment and Supplies and Listing
Appendix B 1 Apnea, Respiratory, Oxygen and Vents January 2022
Appendix B 2 Bandages, Dressings, Gauze, and Tape January 2022
Appendix B 3 Bed Pans, Urinals, Incontinence, Catheters, and Irrigation Equip and Supplies January 2022
Appendix B 4 Beds, Mattresses, and Accessories January 2022
Appendix B 5 Burn Garments January 2022
Appendix B 6 Canes, Crutches, and Walkers January 2022
Appendix B 7 Communication Devices January 2022
Appendix B 8 Decubitus and Ulcer Products January 2022
Appendix B 9 Diabetic Products January 2022
Appendix B 10 Dialysis Equipment and Supplies January 2022
Appendix B 11 Dry Heat Application, TENS, NMES January 2022
Appendix B 12 Elastic Support Items January 2022
Appendix B 13 EPSDT Only January 2022
Appendix B 14 Feeding Pumps, Nutritional Supplements, Feeding Kits, and Tubes January 2022
Appendix B 15 I.V. Services Day Rate, Stands, Needles, and Supplies January 2022
Appendix B 16 Miscellaneous Durable and Expendable Supplies January 2022
Appendix B 17 Orthotics January 2022
Appendix B 18 Ostomy and Colostomy Pouches January 2022
Appendix B 19 Traction Equipment January 2022
Appendix B 20 Wheelchairs and Accessories January 2022
Appendix B 21 Excel Version with all Categories of Appendix B January 2022
- Programs and Initiatives
-
Services
- Aging and Disability Services
- Enrollment and Disenrollment
- Durable Medical Equipment
- Level of Care Review
- Waivers
Training
Durable Medical Equipment