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Durable Medical Equipment (DME)

 DME Overview:

Supplies and Durable Medical Equipment (DME) is defined as equipment that can withstand repeated use and that generally would be of no value to the client in the absence of a disability, illness, or injury. DME benefits are available to all clients enrolled in a Colorado Medical Assistance program if they are residing in the community and it is medically necessary.


Helpful Links:

DME Fact Sheet

Durable Medical Equipment (DME) & Supplies Billing Manual

Medicaid Fee Schedules

Provider Bulletins

Durable Medical Equipment and Disposable Medical Supplies rule


Approved DME Benefit Coverage Standards:

Alternative and Augmentative Communication Devices (AACDs) - Effective 9/30/13


Upcoming DME Benefit Coverage Standards:

Wheelchairs: Manual Wheelchair Bases, Power Mobility Devices, Wheelchair Seating, Wheelchair Options and Accessories


Boards & Committees:

Medical Services Board (MSB)

Benefits Collaborative


HCPF DME News:

  • DME and Supply Rate Increase:

The Department has received final approval for supplier rate increases. The rate increase is effective beginning July 1, 2013. The Department is working on adjusting claim reimbursement accordingly. Please refer to the DME rules, Section 8.590.7.I, for the approved pricing methodology.

  • Medicare DMEPOS Competitive Bidding:

Clients who are Medicare-Medicaid enrollees living in the competitive bidding area (CBA) as well as suppliers providing services to those clients must comply with the Medicare DMEPOS competitive bidding rules. Medicaid will not assume responsibility as the primary payer for any claims or services that have not been properly processed under these rules. Claims submitted in compliance with the competitive bidding rules will still be payable by Medicaid as the payer of last resort. Additionally, non-contract Medicare suppliers should continue to process Medicare-Medicaid crossover claims through Medicare prior to submitting to Medicaid for all items and/or Medicare-Medicaid enrollees excluded in the competitive bidding process. Suppliers are responsible for being in compliance with claims and billing rules. Please visit the DMEPOS Competitive Bidding Program website for detailed information on the product categories and competitive bidding areas included in the Round 2 of the National Mail-Order competitive bidding program.

Non-Contract Suppliers Serving Full-Benefit Medicare-Medicaid Enrollees

 Information on billing requirements for competitively bid items where Medicare’s coverage criteria differs from Medicaid’s coverage criteria is not available at this time; however, guidance for suppliers will be posted on this webpage and in the provider bulletin when the process has been finalized.

 

Contact the Department:

Phone: 1-800-221-3943 | Email: Customer.Service@hcpf.state.co.us