DME billing

DME Policy


The DME program covers medically necessary durable medical equipment, prosthetics, orthotics, and disposable medical supplies (DMEPOS); which includes oxygen and related supplies, parenteral and enteral nutrition and medical foods.

Durable Medical Equipment (DME) is medical equipment that:

* Can withstand repeated use; Is primarily and customarily used to serve a medical purpose;
* Is generally not useful to a person in the absence of illness or injury; and

* Is appropriate for use in the home.

Products and services must be medically necessary, safe and appropriate for the course and severity of the


condition using the least costly and equally effective alternative to meet the recipients needs.

Getting Authorization



Prior Authorization Some DMEPOS services/items require prior authorization. Requests maybe submitted through the Online Prior Authorization System (OPAS) or by fax using form.

It is critical to submit complete and accurate clinical documentation on prior authorization requests. Documentation must include the prescription and fully support medical necessity of the item. When submitting supporting medical documentation online, the name and credentials of the provider who supplied the information are required. Failure to provide this information may result in a denied request and/or may delay the determination.

Claims/Billing


* Provider must submit claims in accordance with the Healthcare Common Procedure Coding System (HCPCS) and national industry standards.
* Providers can only bill for the actual number of medically necessary units dispensed/delivered to a recipient, regardless of the number of units allowed by policy and/or prior authorization.
* Providers must bill their usual and customary charges.

Bundled Services


For any HCPCS code description in which various components are identified, the components may not be billed separately. The Nevada Medicaid rate includes all items in the description.

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