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.