MedicaidPrior AuthMedium impact
Information Request to Determine Reimbursement for DME Prior Approvals
Illinois Medicaid - HFS·IL · PM&R (Physical Medicine & Rehab), Orthopedics, Neurology·Provider Notice
Effective date
Aug 1, 2011
We identified it
Jun 21, 2026
Summary
Starting August 1, 2011, DME providers must submit actual dealer acquisition cost and manufacturer's suggested retail pricing (MSRP) with all prior approval requests for mobility devices, equipment, and supplies. Requests without cost information and medical documentation will be returned as insufficient.
Action Required
By August 1, 2011: DME providers must update prior approval request procedures to include dealer acquisition cost and MSRP for all items, verified by manufacturer/wholesaler cost statements and catalog pricing. Add medical necessity documentation requirements to all requests. Incomplete requests will be returned by the department.