Durable Medical Equipment Providers

For the latest updates please visit our Medicaid Provider Updates page.

Download: DME Provider Manual - (November 2019)

Effective: March 2007Revised: December 2022

At least one of the following conditions must be present for coverage of rental up to 6 months:

For coverage after the initial six-month period, additional month’s coverage must be prior authorized by the Department and the following conditions must exist and be documented by the physician/practitioner.

a. Number of apnea episodes during the previous two-month period of use; and b. Infant continues to have significant alarms. (Log must be kept on file.); and c. Unresolved symptomatic apnea; and d. Tests and results of tests performed during the previous two-month period of use; and e. Estimated additional length of time monitor would be needed; and f. Any additional pertinent information the physician may wish to provide.

According to the American Academy of Pediatrics, home apnea monitoring is not recommended in infants with siblings that were victims of sudden infant death syndrome (SIDS) and monitors used in these situations are not covered. Home apnea monitoring has not been proven to prevent sudden unexpected deaths in infants.

Date Revised: January 2017

Removed coverage criteria for apnea monitor requests for infants with siblings that were victims of sudden infant death syndrome (SIDS) and monitors and added non coverage rationale. Reviewed and revised.

Reviewed and made the following revisions.

1. Added Continued Coverage section and the following:

2. Added new department logo.

3. Removed for coverage after the initial six-month period, additional month’s coverage must be prior authorized by the Department and the following conditions must exist and be documented by the physician: infant continues to have significant alarms. (Log must be kept on file.) and unresolved symptomatic apnea.

Date Revised: June 11, 2020

4. Added to the Documentation Requirement section:

Date Revised: Dec. 27, 2022

Reviewed and reformatted. Added new logo.

Date Revised: June 23, 2023

Reformatted on HHS website.

Effective Date: May 2017Revised Date: December 2022

A wearable cardioverter defibrillator (WCD) is an external device (vest-like garment) that contains the following components:

The WCD monitors cardiac (heart) rhythm and delivers an electrical shock if a life threatening ventricular arrhythmia is detected. The WCD is worn continuously, 24 hours per day.

The FDA has not approved use of the WCD for the indications listed below. Therefore, the WCD is not medically necessary and not covered for a member who meets any one of the following:

Date Revised: May 2017

Established criteria as listed in policy

Date Revised: January 3, 2020

Reviewed. Added new Department logo and changed 60 days to 90 days.

Date Revised: December 22, 2022

Updated with new logo

Date Revised: June 26, 2023

Reformatted on HHS website.

Effective Date: July 1, 2011Revised Date: November 2022

A bath/shower chair sits in the bathtub or shower for bathing in the seated position. A tub transfer bench goes across the side of the tub and allows a member to safely slide into the tub and sit for bathing.

Specialty bath/shower chairs are covered when a member requires postural support and stability while bathing. The frame is adjustable to provide tilt and recline to meet various positioning needs.

Limited to one every five years.

All of the following criteria must be met:

All accessories for the specialty chair require medical justification and must be included in the medical information provided.

Accessories/items with the miscellaneous code E1399 require service authorization and a manufacturer invoice reflecting the acquisition cost on the requesting service authorization.

Other accessories such as bath chair lateral supports, chest or pelvic straps, or wedge and pommel cushions are medically necessary when a member requires additional support to maintain the head or trunk in proper alignment or to maintain the member safely on the bath chair while bathing.

Indications for coverage of the tilt/recline feature:

Indications for coverage of a non-standard seating system:

Indications for coverage of foot plates:

Indications for coverage of elevating leg rests:

Indications for coverage of a heavy-duty shower/commode chair:

Documentation Requirements:

Date Revised: March 2017

Reformatted and reviewed.

Date Revised: November 2019

Reviewed. Header logo replaced with new logo.

Revised Documentation Requirements section:

Deleted:

Added:

Date Revised: November 23, 2023

Deleted:

Added:

Reviewed. Header logo replaced with new logo.

Effective Date: March 2007Revised Date: December 2022

Documentation Requirements:

Date Revised: January 2017

Reviewed and revised.

Date Revised: February 2020

Added new logo and added to Documentation Requirement section bullet #1, #2 and #4.

Date Revised: December 22, 2022

Updated with new logo

Effective Date: March 2007Revised Date: November 2022

Coverage allowed if ALL of the following conditions are present:

Guidance:

Non-Covered:

Documentation Requirements:

List of covered blood glucose monitors and billing guidance:

Except for Medicare crossovers, ND Medicaid pays for blood glucose test strips, lancets, insulin syringes, and pen needles through pharmacy claims (see Preferred Diabetic Supply List). Medicare crossover claims will be paid through DME provided Medicare pays first (see Medicare policy link).

Date Revised: January 2017

Reviewed and revised.

Date Revised: November 2019

Reviewed and updated Coverage allowed section removed “There is a physician’s order for the monitor and supplies, and”. Documentation Required section deleted.

Added:

Documentation Requirements:

Header logo replaced with new logo.

Date Revised: February 7, 2022

Reviewed and revised:

Inserted in Documentation Requirements:

Deleted in Documentation Requirements:

Date Revised: November 23, 2022

Reviewed and remains unchanged. Header logo updated with new logo.

Effective: March 2012Revised: November 2022

Manual (E0602NU) and Electric (E0603NU) breast pumps should be used to promote lactation and to provide lactation support when natural feeding is not possible. These items are purchase only and do not require service authorization.

Hospital grade electric breast pumps (E0604RR) do not require service authorization for the initial one-month rental. If additional months of rental is needed a service authorization is required.

The Women, Infants, and Children's (WIC) Nutrition Program stocks a supply of hospital grade electric pumps. If the child is on the WIC program, the hospital grade breast pump must be obtained through the WIC Program as long as supply is available.

Please note: If the member is in need of lactation services, North Dakota Medicaid encourages the member and provider to work together to contact the Women, Infants, and Children's (WIC) program. WIC is a program for pregnant women, breastfeeding women, infants, and children younger than five and is available in all counties in North Dakota.

For more information or to find vour local WIC office please call 1-800-472-2286 or go to https://www.hhs.nd.gov/food-programs/WIC.

Coverage Limits:

A service authorization of hospital grade electric breast pump beyond 1 month is required. Medicaid Utilization Review staff will review the records to determine if below criteria are met:

Date Revised: January 2017

Reviewed and revised.

Date Revised: February 2020

Add new logo and added three bullets to the required documents - prescription, practitioner note and medical necessity.

Date Revised: November 2022

Reviewed and revised. Header logo updated with new logo.

Watch "How to Submit a DME Service Authorization Training Video" (Feb. 4, 2021)

If you have questions regarding durable medical equipment or supplies, you may e-mail questions to [email protected] or telephone (701) 328-2764. For billing questions, contact Provider Relations at (701) 328-7098.