Durable Medical Equipment (DME)

In response to the Coronavirus Disease 2019 (COVID-19), the Alabama Medicaid Agency has compiled a summary of changes and allowances made by the Agency as they apply to DME providers.

Medicaid has extended all expiration dates below related to the Coronavirus (COVID-19) emergency.

• See all ALERTS here:https://medicaid.alabama.gov/alerts.aspx
• Medicaid COVID-19 updates here:          https://medicaid.alabama.gov/news_detail.aspx?ID=13729
• Updated signature requirements during the state of emergency, effective 3/16/20
  • See ALERT here:         https://medicaid.alabama.gov/alert_detail.aspx?ID=13755
• Existing Prior Authorizations can temporarily be extended for 30 days, effective 3/16/20
• New Prior Authorizations will still be processed through normal means, but with the following temporary modifications during the state of emergency, effective 3/16/20:
  • Face to Face evaluation is not required; telemedicine is allowed
  • Prescription orders is not considered outdated if 90 days past date written
  • EPSDT screening/referrals not needed for prior authorization

DME providers,

During the state of emergency, the Alabama Medicaid Agency hopes to provide additional options to submit a prior authorization request (or renewal request).  Please see below.  

Options for Submitting Prior Authorization (PA) requests to Comagine Health due to COVID 19 State of Emergency

• If faxing via Form 471:

• Single Request - Only complete the Supplier Information section and then add the PA number and a brief comment (i.e. PA extension).
• Multiple Requests-Only complete the Supplier Information section and then attach a list of the PAs and a brief comment (i.e. PA extension).

• Requests may be faxed to 888-213-8548 (the fax number is located on the Form 471, bottom of page). 

• You may call a Comagine Health reviewer directly regarding your PA request(s) at 888-213-7576. 

• Please reference the provider Portal for PA extension updates.

• Please feel free to contact Comagine Health as needed for any questions at 888-213-7576.

DME General Information

DME providers must be licensed annually by the Alabama Board of Home Medical Equipment Services (HME). For more information regarding how to become a licensed HME provider, visit  www.homemed.alabama.gov and click on the forms link.

For questions about Durable Medical Equipment (DME):  Email DME Program Phone: 334-242-5050

ATTENTION: All DME Providers: A new feature has been added to the provider web portal. DME providers will have the option to view all DME PAs for a recipient, even those requested by another provider. Please review the provider web portal User Manual for instructions. Contact the DXC Electronic Media Claims (EMC) Helpdesk for assistance at (800) 456-1242 or (334) 215-0111.

DME Fee Schedules

• DME-POP Fee Schedule
• DME Manually-Priced Fee Schedule
• DME EPSDT Referral Fee Schedule
• 2020 DME CURES Act Fee Schedule

DME Manuals

• Provider Manual - Chapter 14 - DME
• Provider Manual - Appendix P - DME Procedure Codes and Modifiers
• Administrative Code - Chapter 13 - Supplies, Appliances, and DME  

DME Policy & Procedures

• Diabetic Supply Coverage Policy - Effective 3/1/12
• DME Provider Reimbursement Adjustments Review - 9/1/20
• Checklist for Durable Medical Equipment - Information on denials, reasons for recoupments, where to find information in the Medicaid Provider Billing Manual, free tools and contacts  for providers to use in preventing fraud and abuse.

DME Forms

• Form 384 - Wheelchair/ Seating Evaluation
• Form 386 - Wheelchair Modification
• Form 360 - Oxygen Therapy - Updated 11/9/20
• Alabama Medicaid Dossier Submission Form/ Packet

DME Provider Lists

• DME Providers - Updated 4/1/20
• Phototherapy Providers - Updated 11/1/19
• DME Wheelchair Repair Providers - 10/24/13
• Hospitals Participating in PT Evaluations for Motorized Wheelchairs - 5/9/14

DME Prior Authorization Public Checklists

• 01-01 External Ambulatory Infusion Pump
• 01-02 Extra Wide Heavy Duty Walkers
• 01-03 Pressure Reducing Support Services
• 01-04 Home Infusion Therapy
• 01-05 Iron Chelation Therapy
• 01-07 Short Term Rental Policy for Reclining Wheelchairs
• 01-08 Incontinence Supplies
• 01-11 Pulse Oximeter Policy
• 01-13 Standard Wheelchair and Accessories
• 01-14 Heavy Duty Wheelchairs and Accessories
• 01-15a Custom/Power Wheelchairs and Accessories for Children
• 01-16a Wheelchair Elevating Leg Rest
• 01-18 Home Phototherapy
• 01-20 High Frequency Chest Wall Oscillation/Air Pulse Generator System
• 01-21 Home Blood Glucose Monitor and Supplies
• 01-22 Enteral Total Parenteral Nutrition
• 01-23 CPAP
• 01-24 BiPAP
• 01-25 Pressure Ventilator Volume Ventilator
• 01-27 Controlled Dose Drug Inhalation
• 01-28 Gait Trainers
• 01-30 Protective Helmet
• 01-31 Tracheostomy Supplies
• 01-32 Cough Stimulation Device
• 01-33 Special Ostomy Supplies
• 01-34 Transfer Board
• 01-35 Specialty Walkers for Children
• 01-36 Specialty Car Seats
• 01-37 External Defibrillator
• 01-39 Hospital Bed and Accessories
• 01-40 Straight Tip Catheters
• 01-41 Other Scoliosis Procedure
• 01-42 Wheelchair Elevating Leg Rest
• 01-46 Continuous Glucose Monitor (CGM)

 

DME Alerts and Updates

• Comagine Health ADMEA Presentation
• DME Advisory Board Meeting summary - 1/8/21
• ALERT regarding DME CURES Act Fee Schedule - 4/20/18
• ALERT on DME Program Changes - 4/29/14
• Clarification to ALERT on Reversal of Payment Reductions - 9/18/19
  • Clarifies processing of manually-priced items  Click for ALERT
• Follow-Up Q&As: CMS Face-to-Face Requirement for Certain DME Equipment - 10/19/18