CPAP Criteria
Prescribers no longer need to contact the DME Helpdesk for a CPAP override if a home sleep study is performed. The home sleep study criteria have been integrated into CyberAccess to be used for DME pre-certification.
DME Walker Criteria
MO HealthNet requires pre-certification for standard walkers, walkers with trunk support, walkers with variable wheel resistance, and heavy duty walkers. However, MO HealthNet does not cover rollator walkers. Therefore, rollator walkers cannot be billed to MO HealthNet under HCPCS E0143 or E0149.
Durable Medical Equipment (DME) Program Policy Clarification for Custom and Power Wheelchairs Provided in a Skilled Nursing Facility
MO HealthNet has updated the Durable Medical Equipment (DME) Provider Manual to clarify policy related to the physician face-to-face evaluation when providing custom and power wheelchairs in a skilled nursing facility. The policy clarification can be found in Section 13.18.C of the manual located here.
Medical Device Recall
On June 14, 2021, Philips issued a recall notification for specific affected Continuous Positive Airway Pressure (CPAP), BiLevel Positive Airway Pressure (BiLevel PAP) devices, and Mechanical Ventilators.
Please contact Philips for recall information and repair/replacement process. MO HealthNet is not responsible for replacing items related to the recall.
https://www.usa.philips.com/healthcare/e/sleep/communications/src-update
Durable Medical Equipment Prior Authorization
Durable Medical Equipment (DME) providers are required to obtain prior authorization (PA) for certain services before delivery of the services. The prior authorization (PA) process is a paper process. Providers are encouraged to submit their PA requests by facsimile (fax) to 573-659-0207. The following criteria apply when submitting PA requests by fax: