Durable Medical Equipment (DME) Pre-Certification Requests from Third Party Vendors
Durable Medical Equipment (DME) Pre-Certification Requests from Third Party Vendors
MO HealthNet does not accept Durable Medical Equipment (DME) pre-certification requests from third-party vendors. Pre-certification of DME is a two-step process:
1. The MO HealthNet enrolled physician who prescribed the item must initiate the request for pre-certification.
2. The enrolled DME provider dispensing the item must access the pre-certification initiated by the physician.
PACE Benefit Table
Program of All-Inclusive Care for the Elderly (PACE) Benefit Table
The Program of All-Inclusive Care for the Elderly (PACE) is administered by MO HealthNet and Medicare to provide comprehensive health care, social, recreational, and wellness services to its participants. One of the main goals of PACE is to allow older adults to live safely in their homes instead of nursing facilities. As of May 3, 2024, PACE organizations are active in St. Louis and Kansas City, with a new PACE organization coming to the Springfield area later this year.
Gait Trainers and Accessories
Gait Trainers and Accessories
Healthcare Common Procedure Coding System (HCPCS) code E1399 should not be used when requesting prior authorization for a gait trainer. The following codes should be used:
- E8000 (Gait Trainer, Pediatric Size, Posterior Support, Includes All Accessories)
- E8001 (Gait Trainer, Pediatric Size, Upright Support, Includes All Accessories)
- E8002 (Gait Trainer, Pediatric Size, Anterior Support, Includes All Accessories)
CPAP Criteria
Prescribers no longer need to contact the DME Helpdesk for a CPAP override if a home sleep study is performed. The home sleep study criteria have been integrated into CyberAccess to be used for DME pre-certification.