Date: September 23, 2021
To: Enrolled Durable Medical Equipment and Supplies Providers
Re: Prior Approval Required on All Wheelchair Repairs Greater Than $750.00 Effective July 6, 2021
This notice informs durable medical equipment (DME) providers of a change in state law (Public Act 102-0043) that affects prior approvals for wheelchair repairs. This applies only to the Medicaid fee-for-service program.
Effective July 6, 2021, the threshold amount required for prior approval of wheelchair repairs has changed. If the repair cost exceeds $750.00 (previously $400.00), prior approval will be required. DME providers may not divide wheelchair repairs into separate claims for the purpose of staying under the $750.00 threshold. HFS will be monitoring DME billing claims for compliance on this issue.
Questions regarding fee-for-service customer repair approvals may be directed to a DME billing consultant within the Bureau of Professional and Ancillary Services at 1-877-782-5565 Option 3, then Option 2. Questions regarding managed care plan customer repair approvals may be directed to the applicable managed care plan.
Kelly Cunningham, Administrator
Division of Medical Programs