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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2. Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.4 Durable Medical Equipment (DME) Supplier (CCP) : 2.4.3 Prior Authorization and Documentation Requirements : 2.4.3.2 Equipment Modifications

2.4.3.2
Equipment Modifications
A modification is the replacement of a component due to changes in the client’s condition, not the replacement of a component that is no longer functioning.
DME that has been delivered to the client’s home and then found to be inappropriate for the client’s condition will not be eligible for an upgrade within the first six months following purchase. All modifications that are made within the first six months after delivery are considered part of the purchase price.
However, CCP may consider prior authorization of modifications to custom equipment if a change occurs in the client’s needs, capabilities, or physical/mental status that cannot be anticipated. Documentation must include:

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.