DME Program Quarterly Updates

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TO: Durable Medical Equipment (DME) and Prosthetic, Orthotic and Pedorthic (POP) Providers

RE: DME Program Quarterly Updates

The following updates to DME/POP policies are being made:

1. Effective October 1, 2026, enrollment criteria for prosthetics and orthotics providers are being updated. Please refer to the Alabama Medicaid DME and POP Provider Enrollment Requirements ALERT published on August 12, 2026. https://www.medicaid.alabama.gov/alert_detail.aspx?ID=16789

2. Effective July 1, 2026, Augmentative Communication Devices (ACDs) can be delivered to the speech language pathologist (SLP) from the manufacturer for initial set-up and training. In cases where the ACD is shipped to the SLP, the SLP is responsible for generating a delivery ticket which includes a statement of training, a statement of receipt, the product name, the product model and the date. The delivery ticket must be signed by the recipient or representative as outlined in Chapter 1 of the Alabama Administrative Code and sent back to the manufacturer. https://www.medicaid.alabama.gov/content/9.0_Resources/9.2_Administrative_Code.aspx

3. A checklist has been published for ACD coverage criteria. https://www.medicaid.alabama.gov/documents/4.0_Programs/4.3_Pharmacy-DME/4.3.16_DME_PA_Checklists/4.3.16_01-12_Public_Checklist_ACD_9-14-26.pdf

4. Effective October 1, 2026, benefit limits for A7520 - trach/laryngectomy tube, non-cuffed and A7521 - trach/laryngectomy tube, cuffed, have been updated to six (6) per calendar year for the adult population (ages 21+). No changes have been made to the benefit limit for EPSDT eligible children (ages 0-20); the limit remains at five (5) per calendar month.

DME Program Reminders:

1. Shipping, handling and freight charges are non-covered.

2. All prior authorization (PA) requests must be accompanied by a valid prescription/order. PAs submitted without a valid order will not be considered timely. Please refer to Chapter 14 of the Provider Billing Manual for more information.

3. It is the responsibility of the provider to ensure that all supplies, equipment and/or services are both requested and billed with the CMS assigned HCPCS code. The use of miscellaneous HCPCS codes is reserved for supplies, equipment and/or services that are assigned by CMS to E1399 or do not have a CMS assigned HCPCS code. Providers should contact the DME Program Manager if assistance is needed in determining the appropriate HCPCS code for a DME item. Please refer to Chapter 14, section 14.2.44 for more information on the use of miscellaneous HCPCS codes.

4. For all non-Medicare third-party claims, providers are responsible for reporting primary payer explanation of benefits (EOB) data exactly as it is reported on the EOB. Misrepresentation of EOB data may result in recoupment. For more information regarding third-party billing, please visit Chapter 5 of the Provider Billing Manual.

5. For all non-Medicare third-party claims, if the primary payer requires a product or service to be billed on another benefit, the recipient must use the appropriate provider and benefit per the primary payer policy. For more information on coordination of benefits please visit https://www.medicaid.alabama.gov/content/7.0_Providers/7.1_Third_Party/7.1.6_Coord_Benefits.aspx

Policy questions concerning this ALERT should be directed to the DME Program at (334) 242-5050.

The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 20 26 American Medical Association
and © 20 26 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.