Durable Medical Equipment (DME) Benefit and Covered Service

The durable medical equipment (DME) covered services provided under the DME benefit, along with their specific procedure code(s) accepted for claim and payment, are noted within the attached AHCA Medicaid DME Provider Fee Schedule links.

In addition, to covered DME services noted with the Florida Medicaid fee schedule, AmeriHealth Caritas Florida covers DME services when authorized and billed under the miscellaneous procedure codes (E1399 and A9900). These services categories include, but are not limited to the following:

DME description
PleurX drainage kits
Cotton-tipped applicators
Customized tracheostomy supplies
Farrell bags and valves
Omnipod insulin delivery systems
Personal wipes
Supplies (tracheostomy cuff)
Customized equipment
Customized repair supplies

Reminder: When rendered in POS 12 (home), these specific excluded services should be authorized by and billed to AmeriHealth Caritas Florida:

  • Communication boards.
  • ALL contraceptive medications and supplies.
  • Cranial helmets.
  • ALL end-stage renal disease (ESRD) services rendered in the home.
  • Implantable device supplies (e.g. supplies related to cochlear implants, permanent birth control, urogynecologic surgical mesh implants).
  • Inhalation solution (solution should be obtained through member’s pharmacy benefit).
  • OB/GYN home health services (services provided by Optum OB Home Care Services). Please contact Optum OB Home Care directly by phone at 1-888-950-3963 or via fax at 1-866-252-4293 or 1-866-731-8011 prior to providing these services.
  • Orthotics or prosthetics.
  • Vision, hearing, and speech pathology services. (HCPCS codes in the “V” series)

Providers may call the Provider Services Contact Center at 1-800-289-7799, option 7, for billing assistance. If you have any questions, please contact your Account Executive or call Provider Services at 1-800-617-5727.

Coastal Care Services Provider Billing Manual (PDF)

AHCA DME Provider Fee Schedule (PDF)