DME Policy Reminder for Replacing Medical Equipment

Per clinical coverage policy 5A, section 5.9 - Replacing Medical Equipment:

Medicaid or NCHC may consider replacing the item, when repairing is no longer cost-effective and the item is out of warranty. Refer to Attachment A, Section C: Procedure Codes(s).

 

Note: When requesting prior approval for the replacement of an item before its usual life expectancy has ended, explain on the CMN/PA form why the replacement is needed. Specific documentation, in addition to the prescription and CMN/PA form, is required in the following situations:

 

a. In cases of equipment loss or damage beyond repair, a letter from the social worker, case manager or child service coordinator explaining the circumstances.

b. In cases of theft, a copy of the police report or a letter from the appropriate person with knowledge of the occurrence, such as the school principal, social worker, etc.

c. In cases of equipment destruction by fire, a copy of the fire report.

 

For equipment loss or damage due to hurricane Matthew, CSRA will also accept documentation of damage from the NC Division of Emergency Management, Federal Emergency Management Agency, or other state or local authorities and agencies.