Durable Medical Equipment (DME) is equipment such as wheelchairs, walkers or bath chairs, and supplies such as feeding tubes, catheters and dressings. When medically necessary, Medicaid will pay for medical supplies and equipment. The supplies and equipment must be reasonable and cost effective. Medicaid will also cover these if the participant is in the community, or living under a home health agency plan of care that meets the requirements found in the state rules.
All requests require a prescription signed by a doctor, nurse practitioner, or physician assistant. No verbal orders or stamped signatures will be accepted. The medical necessity rationale for the item must be submitted. This supporting documentation can be a letter of medical necessity, physician notes, or therapy notes. Refer to the Provider Handbook, Suppliers, to learn the criteria for documents needed to review the item being requested.
Urgent requests are given priority. An urgent request constitutes equipment the participant needs to discharge from a facility – for example, hospital, skilled nursing facility or rehabilitation facility.
For EPSDT requests use the program specific Prior Authorization Request Form. A special EPSDT Request Form is not required. EPSDT reviews are done at the Medical Care Unit’s discretion. If the request does not meet state plan criteria it can be reviewed under EPSDT. Approval under EPSDT will be noted in the decision notes. Please, remember that billing must submit claim with the EP modifier.
The status of a prior authorization request may be checked online at the Molina Health PAS portal under “Authorization Status”, using your NPI, or by contacting Molina at (866) 686-4272. If you have questions on a Denial, click on the Notes, which will explain the reason for the Denial, or ask the Molina Customer Service Representative to read you the Notes in the Denial.
Frequently Asked Questions can answer most of your DME questions. If you have further questions you can email our DME Representative.