Durable Medical Equipment

The South Carolina Department of Health and Human Services (SCDHHS) is amending physician signature requirements for continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) devices. Effective March 1, 2018, the date of the physician’s order, resulting from sleep study interpretation, must be within 90 days before the date of service on the Medicaid Certificate of Medical Necessity (MCMN). For service dates before March 1, 2018, providers will continue to abide by the requirement that physician signatures are required once every 60 days.

The South Carolina Department of Health and Human Services (SCDHHS) is amending current physician signature requirements for the following forms located in the Durable Medical Equipment (DME) Provider Manual:

1. DME 001 (Equipment and Supplies)

2. DME 003 (Power/Manual Wheelchairs and/or Accessories)

3. DME 004 (Orthotics, Prosthetics and Diabetic Shoes)

Effective Dec. 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will add criteria and prior authorization guidelines for ventilators to the Durable Medical Equipment (DME) Provider Manual for DME providers. This policy will be posted in the DME Provider Manual located on the SCDHHS website, www.scdhhs.gov.

The ventilator policy guidelines are as follows:

Effective Aug. 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will amend the delivery method policy for Durable Medical Equipment (DME) providers. This policy change will be posted in the DME manual located on the SCDHHS website, www.scdhhs.gov.

Effective July 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will no longer require incontinence supply providers to obtain a Medicaid Certificate of Medical Necessity (MCMN) (Form DME001) for gloves provided to Healthy Connections Medicaid members enrolled in the Community Support Waiver, Head and Spinal Cord Injury Waiver and Intellectual Disabilities/Related Disabilities Waiver. Incontinence supply providers are responsible for obtaining the Physician Certification of Incontinence, SCDHHS Form 168IS, prior to delivering incontinence supplies.

Effective June 1, 2014, South Carolina Department Health and Human Services will amend the non-emergency transportation policy for self- administered oxygen dependent beneficiaries discharged from inpatient hospitals or emergency rooms.  This policy change affects Hospitals, Physicians, Ambulance and Durable Medical Equipment (DME) providers.  This policy change will also be posted in the Hospital, Physicians Laboratories and Medical Professional, Ambulance and Durable Medical Equipment manuals located on the SCDHHS website: www.scdhhs.gov.  

Effective immediately the following National Drug Codes (NDCs) may be billed through the Point of Sale (POS) system and do not require Prior Authorization: 

Effective on or after October 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will implement the National Correct Coding initiative (NCCI) Procedure to Procedure (PTP) edits for Durable Medical Equipment (DME).  This will affect services related to wheelchair bases (WCB), wheelchair options and accessories (WCOA), and wheelchair seating (WSC).

Effective with dates of services on or after April 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will make the following policy updates.

1. Prior Authorization and Reconsideration Process