Durable Medical Equipment (DME)
Medical Coverage for Durable Medical Equipment (DME), Home Medical Equipment (HME), and Complex Rehab Technology (CRT)
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Indiana Medicaid provides reimbursement for medically necessary medical equipment and supplies. Coverage does not extend to comfort or convenience equipment or supplies or items with luxury features. Medical progress notes from a physician or nurse practitioner that has cared for your child during the last 6 months may be required. Prior approval (PA) or a Certificate of Medical Necessity is required for most items. A written order by a physician, optometrist/ophthalmologist, or dentist is always required.
Durable Medical Equipment (DME) and Home Medical Equipment (HME) are defined as “equipment that can stand repeated use, is primarily and customarily used to serve a medical purpose, and generally is not useful to a member in the absence of illness or injury.” (405 IAC 5-19-2 and IC 25-26-21-2). Additionally, Complex Rehab Technology (CRT) refers to more complex or customized medical equipment. Families may require a combination of DME, HME, and CRT to meet their child’s needs. Used EquipmentIndiana Medicaid does not reimburse for used DME or HME, except for codes A4638 - Replacement battery for patient-owned ear pulse generator, and A7046 - Water chamber for humidifier, used with positive airway pressure device.
Repair
ReplacementIndiana Medicaid typically does not authorize replacement of large DME or HME items more than once every five years per member. The plan may allow more frequent replacement if there is a change in the member’s medical needs, such as a child outgrowing their current item; however, documentation showing necessity must be submitted in writing, and must show the need is significant enough to warrant a different type or size of equipment. This includes items such as wheelchairs.
Rental vs. PurchaseProviders should base their decision to rent or purchase DME or HME on the least expensive option available for the anticipated period of need. DME or HME items purchased with IHCP funds become the property of FSSA.
Families should consult with a DME provider to learn more about which items can be rented. Typically, items that may be obtained on a rental basis may include basic wheelchairs, traditional hospital beds, basic hydraulic patient lifts, and similar items. More complex or customized equipment (CRT) is usually not available on a rental basis. Not all providers have rental services available. Vision & EyeglassesIndiana Medicaid provides reimbursement for one pair of eyeglasses per year for members ages 20 years and younger. One pair of eyeglasses for members 21 years and older is covered every five years. Replacement frames and lenses are covered only when the medical necessity guidelines are met, or when necessitated by loss, theft, or damage beyond repair (a signed written statement is required).
EPSDTIndiana’s EPSDT program emphasizes early detection to help children achieve appropriate developmental outcomes. Best practices, therefore, often mean that equipment under this program is more readily obtained when the need is clearly demonstrated.
Waiver CoverageThe Medicaid Waiver program covers “specialized medical equipment and supplies to include devices, controls, or appliances, specified in the PCISP, that enable individuals to increase their ability to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live.” (language pulled from DDRS HCBS Waivers Manual; published: July 3, 2024, Policies and Procedures as of July 1, 2024, Version 11.0, Section 10.28).
The plan of care, along with all specialized medical equipment and supplies, must be prior approved. Under the waiver program, allowable equipment includes
If you have other insurance coverage in addition to Medicaid, rules regarding DME, HME, or CRT can vary widely from one program to another. It may be necessary to apply for equipment through additional insurance policies first, in order to obtain a denial, before Medicaid will consider coverage of the item. Contact the program’s manager or the insurance company for details of the program’s policies. |
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Programs and systems change often. It is important to ensure that you are using the most current information. Please check https://www.inf2f.org/fact-sheets.html for the most recent edition.
This fact sheet was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $96,750 with 89% percent financed with nongovernmental sources. The contents are those of INF2F and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.
This fact sheet was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $96,750 with 89% percent financed with nongovernmental sources. The contents are those of INF2F and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.
