MedicaidCoverageHigh impact
DME Program Quarterly Updates
Alabama Medicaid·AL · Speech Therapy, Orthopedics, Podiatry·Provider Notice
Effective date
Oct 1, 2026
We identified it
Sep 18, 2026
Summary
Alabama Medicaid DME program implements four key updates: (1) updated prosthetics/orthotics provider enrollment criteria effective October 1, 2026; (2) Augmentative Communication Devices (ACDs) can now be delivered to speech language pathologists for setup/training with required delivery ticket documentation effective July 1, 2026; (3) new ACD coverage criteria checklist published; and (4) tracheostomy/laryngectomy tube benefit limits updated to 6 per calendar year for adults (A7520, A7521) effective October 1, 2026, with no change to pediatric limits. Policy also reinforces existing reminders on non-covered shipping charges, prior authorization requirements with valid prescriptions, and proper HCPCS coding.
Action Required
REQUIREMENTS:
By September 30, 2026: Billing team must update claims processing system to enforce new benefit limit of 6 units per calendar year (instead of prior limit) for HCPCS codes A7520 (trach/laryngectomy tube, non-cuffed) and A7521 (trach/laryngectomy tube, cuffed) for adult patients ages 21+. Verify that pediatric patients ages 0-20 (EPSDT eligible) remain at 5 units per calendar month. Test system edits to prevent claims exceeding these limits. Document changes in billing procedures manual.
By September 30, 2026: Billing team must review and implement updated prosthetics/orthotics provider enrollment criteria per Alabama Medicaid alert published August 12, 2026. Verify practice's current enrollment status meets new standards.
Immediately: Billing team must obtain and review ACD (Augmentative Communication Device) coverage criteria checklist published September 14, 2026. Update prior authorization procedures to reference new checklist.
By September 30, 2026: If practice bills for ACDs delivered to speech language pathologists, ensure SLP delivery documentation includes: delivery ticket with statement of training, statement of receipt, product name, product model, date, and recipient/representative signature per Alabama Administrative Code Chapter 1. Claims submitted without proper delivery documentation will be denied.
Ongoing: Billing team must continue enforcing that prior authorization requests include valid prescription/order; PAs submitted without valid orders will not be considered timely. Ensure all DME items are billed with CMS-assigned HCPCS codes, not miscellaneous codes unless no specific code exists. Do not bill shipping, handling, or freight charges to Medicaid.