All temporary Durable Medical Equipment (DME) policy flexibilities outlined in COVID-19 Special Bulletins remain in effect as of this publication date. See COVID-19 Special Bulletins for details.
An amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies with an effective date of April 1, 2021, was posted to the NC Medicaid Clinical Coverage Policy web page. Following is a summary of updates:
In the table Related Clinical Coverage Policies, added references to:
- 5A-1, Physical Rehabilitation Equipment and Supplies
- 5A-2, Respiratory Equipment and Supplies
- 5B, Orthotics and Prosthetics
- 11C, Ventricular Assist Devices
In Subsection 5.3.6 Nutrition, medical necessity documentation requirements were updated for clarity.
In Subsection 5.3.9 Miscellaneous Durable Medical Equipment and Medical Supplies, the following medical necessity criteria, without PA, was added for wound care supplies:
Covered wound care supplies may be considered medically necessary for a beneficiary who is required by their medical provider to independently perform dressing changes at home, due to conditions such as the presence of an open wound, surgical site or ventricular assist device driveline site.
In Attachment A: Claims-Related Information, Section C: Procedure Code(s), the following updates were made:
Coverage and quantity limits were added for HCPCS codes A4245 (alcohol wipes, per box), A4247 (betadine or iodine swabs/wipes, per box), A4248 (chlorhexidine containing antiseptic, 1 ml), A4333 (urinary catheter anchoring device, adhesive skin attachment, each), A6207 (contact layer, sterile, more than 16 sq. in but less than or equal to 48 sq. in., each dressing), A6228 (gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing), A6259 (transparent film, sterile, more than 48 sq. in., each dressing) and A6402 (Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing.
Additional Resources
The DME fee schedule and full text of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies is available at NC Medicaid’s Durable Medical Equipment web page. All COVID-19 Special Bulletins are available here.
Contact
NC Medicaid Contact Center, 888-245-0179