PDF Version
TO: All
Providers
RE: DME
Quarterly Updates
The following updates to DME policies are
effective April 1, 2026.
1.
Cranial
Orthosis coverage has been updated to include non-synostotic deformational
plagiocephaly. For full coverage requirements please see the checklist at https://medicaid.alabama.gov/content/4.0_Programs/4.3_Pharmacy-DME/4.3.16_DME_PA_Checklists.aspx.
2.
Enclosed
beds (SleepSafe, Cubby Beds, Beds by George, etc.) billed using E1399 must be billed
with the CG modifier effective April 1, 2026. All prior authorization
requests for enclosed beds using procedure code E1399 submitted on or after
April 1, 2026 must include the CG modifier.
3.
Coverage
for the following procedure codes has been updated to include both adults
(21-99y) and children (0-20y) who have a tracheostomy or laryngectomy. There is
no prior authorization requirement. Please see DME fee schedules located at https://medicaid.alabama.gov/content/Gated/7.3G_Fee_Schedules.aspx for details on limits and reimbursement
rates.
a.
A7507,
Filter holder and integrated filter without adhesive, for use in a tracheostoma
heat and moisture exchange system, each
b.
A7508,
Housing and integrated adhesive, for use in a tracheostoma heat and moisture
exchange system and or with a tracheostoma valve, each
DME Policy Reminders
1.
All invoices submitted must be final
cost invoices (less all available discounts). Claims reimbursed based on
pre-discount invoices are subject to recoupment.
2.
When instructed to submit CMS 1500 paper claims
through postal mail be reminded of the following:
a.
Claims for recipients who have a primary third-party
payor must be accompanied by the TPL attachment form if the primary third-party
payor made a payment.
b.
Claims for recipients who have a primary third-party
payor must be accompanied by the primary third-party payor explanation of
benefits (EOB) if no payment was made.
c.
Detailed instructions can be reviewed in Chapter 5
of the Provider Billing Manual located at https://medicaid.alabama.gov/content/Gated/7.6.1G_Provider_Manuals/7.6.1.1G_Jan_2026.aspx.
3.
The 2026 CURES Act reimbursement rate updates have
been completed, and all associated claims have been reprocessed.
The Provider Billing Manual will be updated with the
new criteria with the next quarterly update. Policy questions concerning this ALERT
should be directed to the DME Program at (334) 242-5050.
The Current Procedural
Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and
other data are copyright © 2026 American Medical Association
and © 2026 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.