MedicaidAdministrativeMedium impact
Instruction from the Health Care Financing Administration Regarding Coverage of Medical Equipment under the Medicaid Program
Maryland Medicaid·MD·Managed Care Organizations
Effective date
Jun 9, 1999
We identified it
Jun 20, 2026
Summary
HCFA has clarified that Medicaid programs and MCOs must provide a meaningful process for beneficiaries to request durable medical equipment (DME) that is not on pre-approved lists. Claims cannot be denied solely because equipment is not on the pre-approved list - an exception/modification process must be available.
Action Required
Immediately: Billing team must establish a process for requesting DME exceptions when items are not on Maryland Medicaid's pre-approved list. Contact Medical Care Policy Administration at (410) 767-1482 for guidance on the exception process. Ensure all DME requests include medical necessity documentation for individual review.