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Medical Supplies, Equipment and Appliances Durable Medical Equipment - MEDICAID - OKLAHOMA (Revised)
Effective date
Jul 8, 2026
Identified
Jul 3, 2026
Summary
Humana Medicaid Oklahoma revised its DME/MSEA coverage policy effective 07/08/2026, establishing specific medical necessity criteria for durable medical equipment. The policy clarifies coverage determinations, repair/replacement guidelines (5-year useful lifetime), and explicitly identifies non-covered items (UpSee Mobility Device, Rolling Shower Frames, Splashy Bath Seat, Oscillating Bed, Overbed Table). Billing teams must update claim adjudication rules to deny non-covered equipment and enforce documented medical necessity requirements.
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What to do
Action · 6 steps
01Before 07/08/2026: Billing team must update claim adjudication system to enforce non-coverage determinations for: E1399 (UpSee Mobility Device), E0240 (Rolling Shower/Chair), E1399 (Splashy Bath Seat), E0270 (Oscillating Bed), and E0315 (Overbed Table).
02For all other DME codes listed (E0250, E0251, E0255, E0256, E0293, E0300, E0301, E0302, E0303, E0304, E0316, E0328, E0329), implement system edits requiring documented medical necessity per policy criteria.
03Configure replacement frequency limit to 5-year intervals; deny replacement requests within 5 years unless condition change documented.
04Update prior authorization templates to reference specific medical necessity criteria (bed-confined status, position change requirements, weight thresholds for heavy-duty beds).
05Train billing staff that repair coverage requires expired warranty documentation and confirmation repair cost is less than replacement.
06Communicate to providers that all DME prescriptions must now include specific functional justification tied to ADL impairment.
If missed: Failure to implement will result in improper approvals and claim denials.
Codes mentioned
E1399E0240E0250E0251E0255E0256E0270E0293E0300E0301E0302E0303E0304E0315E0316E0328E0329
Original notice
Medical Supplies, Equipment and Appliances Durable Medical Equipment - MEDICAID - OKLAHOMA (Revised)
mcp.humana.com · Always check the source before changing claims.
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