Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

Prior Authorization Forms Claim Jumper Newsletters
To locate older documents, access the Archive Page.

General Information for Providers  
Medicaid manual with general information for all provider types.

Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies (DMEPOS) 
This manual has information specific to your provider type.

Coverage Criteria for Anal Irrigation Systems and Catheters 01/2026
Coverage Criteria for Anal Irrigation Systems and Catheters 10/2025
Coverage Criteria for Anal Irrigation Systems and Catheters 04/2025
Coverage Criteria for Bariatric Equipment for Residents of Nursing Facilities 01/2024
Coverage Criteria for Combination Shower Commode Chair and Accessories 01/2024
Coverage Criteria for Cranial Remolding Orthotics Helmets 01/2026
Coverage Criteria for Custom-Made Equipment 01/01/2026
Coverage Criteria for Double Electric Breast Pumps and Milk Storage Bags 12/2024
Coverage Criteria for Enteral and Parenteral Nutrition 01/2024
Coverage Criteria for Gait Trainer 1/1/2024
Coverage Criteria for Glucose Monitors and Related Supplies 01/2024
Coverage Criteria for Hearing Aids 10/2026
Coverage Criteria for Home Oxygen Therapy 01/2025
Coverage Criteria for Home Ventilator 12/9/2025
Coverage Criteria for Hospital-Grade Electric Breast Pump Rentals
Coverage Criteria for Incontinence Supplies 01/2025
Coverage Criteria for Insulin Pumps 01/2024
Coverage criteria for Ketone Test Strips 1/1/2024
Coverage Criteria for MDI Spacer 01/2026
Coverage Criteria for MSRP Reimbursement and Documentation 01/2024
Coverage Criteria for Negative Pressure Wound Therapy Pumps 01/2024
Coverage Criteria for Omnipod Coverage 09/2022
Coverage Criteria for Oral Food Thickener 01/2024
Coverage Criteria for Oral Nutrition 1/1/2024
Coverage Criteria for Total Electric Hospital Beds 01/2025
Coverage Criteria for Wheelchairs and Related Seating for Residents in Nursing Facilities 01/2025

2026

10/13/2026 CMS-Directed Off-Cycle Revalidation for Targeted Moderate- and High-Risk Providers
10/09/2026 Provider Services Portal Notice: Secure Mailbox
10/09/2026 Provider Services Portal Notice: Communication Preferences
10/09/2026 Provider Services Portal Notice: Electronic Linking Requests
10/07/2026 Changes to Gender Dysphoria Coverage in Accordance with New Federal Final Rules
10/01/2026 Updated Hearing Aid and Hearing Aid Systems Coverage Criteria
10/01/2026 Affiliations Requirement in the Claim Modernization System REVISED
10/01/2026 Changes to Medicaid Non-Emergency Medical Transportation
09/30/2026 Claim Adjustment and Void Changes in the Montana Healthcare Claims System
09/17/2026 Resuming Payments to Previously Prohibited Entities Under H.R. 1, Section 71113
09/03/2026 Primary Care Montana (PCMT) Enrollment Deadline Extended - Final Opportunity for Retroactive PMPM Payments
08/26/2026 Big Sky Care Connect Data Quality Resource Website
08/21/2026 Referrals, Medical Orders, and Prior Authorization Requirements Beginning July 1, 2026
07/27/2026 Trading Partner Changes Coming in 2027
05/29/2026 State Fiscal Year 2027 Provider Rate Update
05/11/2026 Temporary PCMT Enrollment and Required Provider Enrollment Actions
05/07/2026 CMS-1500 Coordination of Benefits Processing: Medicare vs. TPL
05/07/2026 Medicaid Expansion Changes
04/10/2026 Affiliations Requirements in the Claims Modernization System
04/07/2026 Not Enrolled with Medicare Provider Notice
03/20/2026 Transition of Passport to Health, CPC+, and PCMH to New Primary Care Montana (PCMT) Program
03/13/2026 Billing Guidance for Incontinence Supplies
03/06/2026 MSRP Reimbursement and Documentation Requirements
03/04/2026 Anal Irrigation Systems Update to Annual Max Units
01/29/2026 DME Claims Processing Instructions - Date of Service
01/12/2026 Montana Healthcare Programs Support Services Holiday Closures

2025

12/30/2025 Provider Licensure, DEA, and CLIA Maintenance
12/18/2025 Submission of Supporting Claim Documentation
12/09/2025 DME Claims Processing Instructions - Home Ventilators (E0465)
10/30/2025 Training Resources on the Medicaid Provider Site
10/06/2025 Notice Concerning H.R.1, Section 71113, Payments to Prohibited Entities
09/04/2025 Medicaid Enrollment for Ordering, Referring and Prescribing (ORP) Providers
07/09/2025 Claim Adjustment Reminder
06/27/2025 Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services Review and Approval Process Through Mountain Pacific
06/25/2025 July 1, 2025 Fee Schedule Updates
06/17/2025 How to Read a Remittance Advice
04/29/2025 Audio-Only Codes
04/23/2025 DME Claims Processing Instructions for Enteral and Parenteral Nutrition
03/31/2025 Payment To Be Suspended for Providers Without Current Financial Information
03/06/2025 Monthly Supply Allowance for Continuous Glucose Monitors - A4238 or A4239
02/11/2025 EFT Authorization Agreement Updated
02/04/2025 Health Behavior Assessment and Intervention Billing Codes
01/15/2025 Total Electric Hospital Bed Coverage Criteria
01/15/2025 Montana Healthcare Programs Support Services Holiday Closures

2024

12/19/2024 IRS Tax Identification Letter Required for Pay-To Providers
12/04/2024 Change in the Double Electric Breast Pump Provider
11/04/2024 Paper Claim Denials
10/18/2024 Electronic Adjustments Void or Void/Replace
10/15/2024 Revalidation Requirements Deadline
07/29/2024 Prior Authorization Requirements When a Member Has Third Party Liability
06/28/2024 January 1, 2024 and July 1, 2024 Fee Schedule Updates
06/20/2024 DME Claims Processing Instructions - Enteral Nutrition Supplies
06/18/2024 Method for Submitting Durable Medical Equipment Prior Authorizations
06/18/2024 DEA Number Required for Prescribers REVISED
06/11/2024 Health Resources Division Claims Appeal Process
05/21/2024 DEA Number Required for Prescribers
05/01/2024 Paperwork Attachments Submission Timing for Electronic Claims
05/01/2024 Eligibility Inquiry and Service Type Code in the MATH Portal
04/19/2024 DME Claims Processing Instructions - Prior Authorization Required to Exceed Maximum Units
04/19/2024 Changes Regarding Opioid Prior Authorization and Medication for Opioid Use Disorder
04/08/2024 Negative Pressure Wound Therapy Pumps (E2402) Do Not Require Prior Authorization
03/27/2024 HHS Letter to Healthcare Providers
03/27/2024 Resources for Providers in Response to the Change Healthcare Cyberattack
03/27/2024 Updated CLIA Claims Editing
03/27/2024 Avoiding Claim Denials
03/27/2024 Location Address and Provider Maintenance Updates
03/19/2024 Electronic Funds Transfer Payment Verification
03/12/2024 Valid Member ID and Eligibility Verification
03/12/2024 Provider Initiated Claims Adjustment
03/05/2024 Voiding Claims With a Prior Authorization
01/26/2024 Criteria Update for Gait Trainers - EPSDT Only
01/23/2024 Montana Healthcare Programs Support Services Holiday Closure REVISED
01/08/2024 Electronic Claim Adjustment Processing Change

2023

12/22/2023 Passport Provider Referral Number on Claims
12/12/2023 Individual Providers Enrolled as Sole Proprietors Due for Revalidation
11/08/2023 Prior Authorization Information
10/31/2023 Managed Care Referrals IHS, Tribal 638, and Urban Indian Organizations REVISED
10/06/2023 Reminder DME Prior Authorization Requirements
09/28/2023 Medical Food or Formula for Phenylketonuria (PKU) Due to Inborn Errors of Metabolism (IEM) REVISED
09/15/2023 Claims Payment Discrepancy Update
09/14/2023 Claims Payment Discrepancy Identified
09/08/2023 Medicaid Claims Payment Delayed
08/01/2023 Provider License Expiration Reminder Letters
07/06/2023 Provider Rate Increases
06/28/2023 Wheelchair and Bariatric Equipment Coverage for Nursing Facility Residents
06/02/2023 New Hearing Aid Review and Approval Process Through Qualitrac Portal
06/01/2023 Billing Guidance for Tracheostomy Tubes for Members Aged 20 and Under
05/26/2023 Medicaid Reimbursement and Court Ordered Services REVISED
05/01/2023 Non-Adjunctive (Therapeutic) and Adjunctive (Non-Therapeutic) Continuous Glucose Monitors (CGMs) Policy Revision
04/10/2023 Resumption of Face-to-Face Requirements for Selected Programs REVISED
03/22/2023 Coverage and Reimbursement Policy for Telemedicine/Telehealth Services
03/22/2023 End of Public Health Emergency (PHE) Effects on Pharmacy Coverage
03/22/2023 Non-Covered Services Agreement Policy Return to Requirements
03/22/2023 Reinstatement of the Primary Care Provider Referral for Passport
03/22/2023 Resumption of Face-to-Face Requirements for Selected Programs
03/22/2023 Resumption of Prior Authorization Requirements Revised 04/03/2023
03/17/2023 End of Temporary Revision to Case Management General Provisions
03/10/2023 Provider Meetings for Medicaid Eligibility Redetermination and Unwinding PHE Flexibilities
03/09/2023 Add-on and E&M Code Editing
03/03/2023 End of Public Health Emergency
01/31/2023 Omnipod Coverage
01/04/2023 Montana Healthcare Programs Support Services Holiday Closures

Noridian Administrative Services
Medicare's DME Administrative Services provider.

Prior Authorization Criteria for Specific Services

Region D DMERC/CIGNA Medicare
The Durable Medical Equipment Regional Carriers (DMERC) website. DMERC processes Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) for Medicare.

Medicare Pricing, Data Analysis, and Coding (PDAC)
This website assists manufacturers and suppliers with DMEPOS billing and coding information. Can call toll-free 1-877-735-1326 or e-mail DME PDAC using their contact form.

SURS Provider Internal Self-Review Protocol 10/2023