All temporary Durable Medical Equipment (DME) policy flexibilities outlined in COVID-19 Special Bulletins remain in effect. An amended version of Clinical Coverage Policy 5A-2, Respiratory Equipment and Supplies with an effective date of Oct. 1, 2020, was posted to the NC Medicaid Clinical Coverage Policy web page.
Topics Related to Durable Medical Equipment Providers
All temporary Durable Medical Equipment (DME) policy flexibilities outlined in COVID-19 Special Bulletins remain in effect. An amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies with an effective date of Oct. 1, 2020, was posted to the NC Medicaid Clinical Coverage Policy web page.
Effective July 1, 2020, coverage of therapeutic Continuous Glucose Monitoring (CGM) products is transitioning from the Durable Medical Equipment (DME) Program to the Outpatient Pharmacy Point of Sale (POS) Program.
This Bulletin clarifies which specific Prior Authorizations were lifted on the March 1, 2020, effective date stated in SPECIAL BULLETIN COVID-19 #15: Medicaid and NC Health Choice Temporary Flexibilities - 1135 Waiver Provisions (posted March 24, 2020), including references all relevant Prior Authorization information included in other Bulletins; replaces the effective dates originally stated in the following Bulletins: SPECIAL BULLETIN COVID-19 #2: General Guidance and Policy Modifications (posted March 13, 2020); SPECIAL BULLETIN COVID-19 #10: Durable Medical Equipment: Temporary Flexibilities Effective March 23, 2020 (posted March 24, 2020); and SPECIAL BULLETIN COVID-19 #11: Outpatient Specialized Therapies Temporary Flexibilities (posted March 24, 2020).
Effective retroactive to March 10, 2020, Medicaid and NC Health Choice plans are temporarily covering weight scales and adding a purchase option for portable pulse oximeters.
Per Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies on the NC Medicaid website, HCPCS code A4252 (blood ketone test or reagent strip, each) has a quantity limitation of 100 test strips per month. Considering the national description of A4252 refers to each test strip, DME providers are reminded to submit their claims with the number of test strips supplied to the beneficiary, not the number of boxes of test strips.
On Oct. 1, 2019, an amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies, was posted to the North Carolina Medicaid website. In addition to correcting numbering, grammatical and style errors, several changes have been made.
NC Medicaid has been reviewing the Medicaid Durable Medical Equipment rates to comply with the new Centers for Medicare and Medicaid Upper Payment Limit requirements. While further review is needed, NC Medicaid wanted to publish this bulletin to provide a status update.
Beginning April 1, 2018, diabetic testing supplies will be transitioned to the North Carolina Medicaid and NC Health Choice Preferred Drug List (PDL) and Roche diabetic testing supplies will remain preferred.
Clinical Coverage Policy 5A-2, Respiratory Equipment and Supplies, is updated to add policy guidelines for home ventilators with a non-invasive interface and to add HCPCS codes E0466 to the Durable Medical Equipment and Supplies fee schedule as a continuous rental.