Skip to main content

Reminder About Medicare Requirements for DME Providers

Last updated on

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

This is a reminder that all providers that are enrolled in Texas Medicaid must be a participating Medicare provider unless otherwise noted. Acute care fee-for-service durable medical equipment (DME) providers are not excluded from the Medicare requirement.

Note: Pharmacy suppliers are eligible to enroll in the Acute Care Comprehensive Care Program (CCP) without being a participating Medicare provider.

This clarification will be added to the Texas Medicaid Provider Procedures Manual, “Section 1: Provider Enrollment and Responsibilities,” subsection 1.1.9.10, “Medicare Participation.”

For more information, call the TMHP Contact Center at 800-925-9126.