Durable Medical Equipment
Beginning Aug. 1, 2020, medical supplies, equipment and appliances, formerly referred to in policy as DMEPOS, were moved to the home health portion of the policy. This change allows some new services to be covered when medical necessity guidelines are met. Some of the notable changes include:
- Nebulizers.
- C-paps.
- Sleep studies.
- Bath and toileting equipment (e.g. commode chair, bath and shower chair, transfer bench).
- Enteral (tube fed) formulas and supplies.
- Incontinence supplies.
- Please note, incontinence supplies for member’s ages 0-20 must be provided by People First Industries.
This change does not include prosthetics and orthotics, as no changes were made to those services. Although there is not a published list of codes covered by age, you may review specific codes in the secure provider portal fee schedule.
Prior Authorization Guidelines
Durable Medical Equipment
- ABI Vest Guideline
- Alarm for Primary Nocturnal Enuresis Guideline
- Apnea Monitor Guidelines
- CGM - Continuous Glucose Monitor
- Cough Assist Device Guideline
- CPM Guideline
- DME Replacement Guideline
- Enteral Nutrition Guidelines
- Enteral Nutrition PA Overview
- Group 2 Pressure Reducing Support Surfaces PA Overview
- Home Exercise Equipment Guideline
- Insulin Pumps PA Overview
- Oxygen and Supplies Guidelines
- Oxygen PA Overview
- Oxygen Certificate of Medical Necessity
- PAP - Positive Airway Pressure Guideline
- Parenteral Nutrition Guideline
- Peristeen Anal Irrigation System Guideline
- Phototherapy Guidelines
- Pulse Ox and Supplies PA Overview
- Pulse Oximeter Guideline
- TPN (Parenteral) PA Overview
- Walkers-Standers-Gait Trainers Guideline
- Wearable Cardio Defibrillator and AED Guideline
- Wheeled Mobility PA Overview
Incontinence Supplies
Vision
Accreditation
Coding
Complex Rehab Technology
For DME Suppliers currently contracted with SoonerCare seeking to obtain CRT Provider Specialty please read over the CRT packet then submit the completed addendum along with the required supporting documentation via fax to 405-530-3261.
Frequently Asked Questions
- FAQ - Wheeled Mobility
- FAQ - Repair items that do not require Prior Authorization
Pricing
Resources
Utilization Worksheets
- CPAP Accessories
- HCPCS "A" Codes
- HCPCS "L" Codes - Orthotics Only
