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2012 Texas Medicaid Provider Procedures Manual

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook : 2. Texas Medicaid (Title XIX) Home Health Services : 2.2 Services, Benefits, Limitations and Prior Authorization : 2.2.2 Durable Medical Equipment (DME) and Supplies : 2.2.2.1 Modifications, Adjustments, and Repairs

2.2.2.1
Modifications are the replacement of components because of changes in the client’s condition, not replacement because the component is no longer functioning as designed. All modifications and adjustments within the first six months after delivery are considered part of the purchase price.
Modifications to custom equipment may be prior authorized should a change occur in the client’s needs, capabilities, or physical and mental status which cannot be anticipated.
Documentation must include the following:
All modifications within the first six months after delivery are considered part of the purchase price.
Adjustments do not require supplies. Adjustments made within the first six months after delivery will not be prior authorized. Adjustments made within the first six months after delivery are considered part of the purchase price. A maximum of one hour of labor for adjustments may be prior authorized as needed after the first six months following delivery.
Repairs to client-owned equipment may be prior authorized as needed with documentation of medical necessity. Technician fees are considered part of the cost of the repair. Repairs require the replacement of components that are no longer functional. Providers are responsible for maintaining documentation in the client’s medical record specifying the repairs and supporting medical necessity.
A DME repair will be considered based on the age of the item and cost to repair it.
A request for repair of DME must include a statement or medical information from the attending physician substantiating that the medical appliance or equipment continues to serve a specific medical purpose and an itemized estimated cost list from the vendor or DME provider of the repairs. Rental equipment may be provided to replace purchased medical equipment for the period of time it will take to make necessary repairs to purchased medical equipment.
Repairs will not be prior authorized in situations where the equipment has been abused or neglected by the client, client’s family, or caregiver. Routine maintenance of rental equipment is the provider’s responsibility. For clients requiring wheelchair repairs only, the date last seen by physician does not need to be filled in on the Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form.
2.2.2.1.1 Accessories
Equipment accessories including, but not limited to, pressure support cushions, may be prior authorized with documentation of medical necessity.

Texas Medicaid & Healthcare Partnership
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