MedicaidPrior AuthMedium impact
Coverage of Prostheses and Repairs of Purchased Equipment for Institutionalized Recipients
Maryland Medicaid·MD·Hospital
Effective date
May 20, 2004
We identified it
Jun 20, 2026
Summary
Maryland Medicaid clarifies coverage policy for prosthetic devices and equipment repairs for institutionalized recipients. Prostheses are reimbursable when recipients are in nursing facilities or other institutions where prosthetic coverage isn't included in the daily Medicaid rate, and equipment repairs over $500 require preauthorization.
Action Required
Billing team must obtain preauthorization for all equipment repair claims over $500 for institutionalized Medicaid recipients. Update billing system to flag repair claims exceeding this threshold. Verify that prosthetic device claims are for recipients in facilities where prosthetic coverage is not included in the daily rate before submitting to Maryland Medicaid.