MedicaidCoverageMedium impact
DMEPOS Costs for Medicaid Members
EmblemHealth·Orthopedics, PM&R (Physical Medicine & Rehab), Physical Therapy +1 more·Provider News
We identified it
Jun 20, 2026
Summary
EmblemHealth Medicaid nursing home members' DMEPOS costs are included in all-inclusive facility rates. Providers cannot bill separately for durable medical equipment, prosthetics, orthotics, and supplies when these costs are already covered in the facility's reimbursement rate.
Action Required
Immediately: Billing team must stop submitting separate DMEPOS claims for EmblemHealth Medicaid members residing in nursing homes. Verify patient residence status before billing and ensure DMEPOS costs are not double-billed when already included in facility rates. Claims will be denied for items included in all-inclusive rates.