Prior Authorization for Durable Medical Equipment
Effective August 1, 2015, BlueChoice HealthPlan requires prior authorization for durable medical equipment (DME) when the amount charged for an item is $500.00 or greater. DME is any equipment that provides therapeutic benefits for treatment of medical conditions or illnesses, can withstand repeated use and is appropriate for home use. Examples of DME include: wheelchairs, hospital beds, orthotics and prosthetics, oxygen and respiratory equipment. If the charge is less than $500.00, we do not require prior authorization.
We still require prior authorization for these ancillary services:
- Hemophilia management
- Home health services
- Home infusion therapy (including enteral/parental feeding)
- Home occupational therapy
- Home speech therapy
- Hospice care
- Private duty nursing
If you do not get a prior authorization for these services or applicable DME, we will deny the services.
If you have questions about this bulletin, please email your provider advocate or call 803-264-4730.