Coverage Requests for Items and Services Not Listed as Covered through the DME

Coverage Requests for Items and Services Not Listed as Covered through the DME Medical Appliance Program A. The Division of Medicaid does not cover items or services through durable medical equipment (DME) and medical appliance program that do not meet: 1. The definition of DME and/or medical appliances, 2. Medical necessity or standard of care criteria, 3. Healthcare Common Procedure Coding System (HCPCS) code descriptors that represent the product, or 4. The approval of the appropriate government regulatory bodies. B. The Division of Medicaid covers medically necessary DME items that are not listed on the fee schedule on a case-by-case basis when: 1. The provider submits documentation that meet the requirements listed in Rule 1.6.A., 2. The request for coverage is limited to one (1) beneficiary, and 3. The request is not used to cover multiple items or multiple beneficiaries. C. Maintenance contracts and servicing fees are not covered under the DME and medical appliance program. For charges related to repair of DME and/or medical appliances, refer to Miss. Admin. Code Part 209, Rule 1.4. Source: 42 U.S.C. § 1395m(a); Miss. Code Ann. § 43-13-121. History: Revised eff. 07/01/2021; Revised eff. 09/01/2018. B. The Division of Medicaid covers medically necessary DME items that are not listed on the fee schedule on a case-by-case basis when: 1. The provider submits documentation that meet the requirements listed in Rule 1.6.A., 2. The request for coverage is limited to one (1) beneficiary, and 3. The request is not used to cover multiple items or multiple beneficiaries. C. Maintenance contracts and servicing fees are not covered under the DME and medical appliance program. For charges related to repair of DME and/or medical appliances, refer to Miss. Admin. Code Part 209, Rule 1.4.