Medical Supplies, Equipment and Appliances Durable Medical Equipment - MEDICAID - OKLAHOMA (Revised)

Before September 2, 2026: (1) Billing team must update claim submission rules in billing system to deny or reject claims for non-covered DME items (UpSee Mobility Device E1399, Rolling Shower Frame/Chair E0240, Safety Sleep Beds E1399, Overbed Table E0315, Hospital Bed Oscillating/Stryker E0270) for Oklahoma Medicaid members. (2) Update prior authorization templates and requirements to include medical necessity documentation per policy criteria: DME must withstand repeated use, be prescribed by healthcare provider, relate to functional needs of physical disorder, not be furnished by hospital/SNF, and be provided in most cost-effective manner. (3) Implement 5-year replacement cycle limit in system for equipment tracking; flag any replacement requests within 5 years for clinical review unless condition change documented. (4) For pediatric walkers (E1399), require documentation of neurological condition or inability to use standard walker before approval. (5) For hospital beds E0302/E0304, require weight documentation exceeding 600 pounds; for pediatric beds E0300/E0328, require bed-confinement documentation with position change requirements. (6) Provider education: Distribute policy to all referring providers explaining non-covered items and covered criteria to reduce claim denials. Failure to implement will result in claims being paid erroneously for non-covered services.