DC Medicaid: DME prior authorization update
AI Summary
Effective October 1, 2025, UnitedHealthcare DC Medicaid is aligning specific durable medical equipment (DME) prior authorization requirements with their Dual Complete Special Needs Plan requirements. This affects hospital beds, patient lifts, power wheelchairs, and respiratory support devices for DC Medicaid and integrated DSNP LTSS enrollees.
Action Required
By October 1, 2025: Billing team must update prior authorization workflows for DME categories including hospital beds, patient lifts, power wheelchairs, and respiratory support devices for DC Medicaid patients. Review the updated CPT code list (modified September 22, 2025) and ensure prior authorization is obtained through the UnitedHealthcare Provider Portal before submitting claims for these DME items.
Plan Types
Medicaid
States
DC
Specialties
pm-r, physical-therapy, occupational-therapy, pulmonology