Durable Medical Equipment, Prosthetic, Orthotics and Medical Supplies Prior Authorization Notice
Nebraska Total Care (NTC), in cooperation with Heritage Health Administrative Simplification Committee, has modified its prior authorization requirements for Durable Medical Equipment, Prosthetic, Orthotics and Medical Supplies (DMEPOS).
Generally speaking, if the Medicaid allowable amount on the Nebraska Medicaid Practitioner Fee Schedule for “DMEPOS” (July 1, 2017) is greater than $750, it will require prior authorization.
If less than $750 allowable amount on the fee schedule, then no prior authorization will be required.
For those codes without an established rate or RNE, NTC has determined when an authorization will be required. See the list of codes that require prior authorization and the list of codes that do not require prior authorization. Both lists are also posted on our Pre-Auth Check page. These changes are effective 9/1/2017.
This guidance does not prevent NTC from post payment review activities as outlined in the Heritage Health Contract.