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Medical Supplies, Equipment and Appliances Durable Medical Equipment - MEDICAID - VIRGINIA (Revised)
Effective date
Aug 26, 2026
Identified
Aug 25, 2026
Summary
Humana Medicaid Virginia updated its DME/MSEA coverage policy effective 08/26/2026, establishing specific medical necessity criteria and non-coverage determinations for select devices including safety sleep beds, UpSee mobility devices, Splashy bath seats, and nonpneumatic compression systems. Billing teams must implement these coverage denials and ensure prior authorization documentation includes the required medical necessity elements outlined in the policy.
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What to do
Action · 8 steps
01By 08/26/2026: Billing team must update denial protocols in Humana Medicaid Virginia claims processing system to automatically deny or require additional clinical justification for the following.
02UpSee Mobility Device (E1399) - mark as not medically necessary.
03Splashy Bath Seat (E1399) - mark as not medically necessary.
04Safety Sleep Beds including Abrams Safety Sleeper, Courtney Bed, Cubby Plus, Safe Haven, Sleep Safe Bed, and Snoo Smart Sleep Bassinet (E1399) - mark as not medically necessary.
05Nonpneumatic Compression Controllers with Sequential Calibrated Gradient Pressure (E0680) - mark as not medically necessary.
06Nonpneumatic Compression Controllers without Calibrated Gradient Pressure (E0681) - mark as not medically necessary.
07For all remaining DME codes (E1399, E0300), ensure prior authorization submissions include documentation verifying: medical necessity per 12VAC30-50-165, practitioner order on CMN/DMAS-352 form, consistency with diagnosis and functional limitations, non-experimental nature, cost-effectiveness, and safe/effective use level.
08Update internal claim review checklists and provider communication materials.
If missed: Failure to implement these denials will result in improper claim payments and potential recovery audits from Humana Medicaid Virginia.
Codes mentioned
E1399E0300E0680E0681
Original notice
Medical Supplies, Equipment and Appliances Durable Medical Equipment - MEDICAID - VIRGINIA (Revised)
mcp.humana.com · Always check the source before changing claims.
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