Medicaid Provider Information
Durable Medical Equipment Providers
Recent Updates
- DME Prior Authorization Form Completion Guide (3/8/2013)
- DME Prior Authorization Adjustment/Completion Guide (3/8/2013)
Please be informed that an updated version of the Certificate of Medical Necessity - Oral and/or Enteral Nutrition (SFN 782) has been posted to e-forms. (www.nd.gov/eforms) Please see #5 of the form with the addition of B4154, as well as #6 with the requirement for documentation to accompany the prior authorization to support pump therapy.
Provider memo: Wheelchair Cushion (E2609/E2617) Cost Increase. (Effective January 2012)
Manuals/Fee Schedules
- Durable Medical Equipment Provider Manual - currently under construction, see updated policies below
- Bath/Shower Chair or Tub Stool/Bench - effective 7/1/2011
- External Infusion Pump - effective 6/15/2011
- External Insulin Infusion Pump - effective 6/15/2011
- Enteral Nutrition - effective 1/1/2012
- Incontinent Garments - effective 1/1/2012
- Breast Pump - effective 1/1/2012
- North Dakota Medicaid DME Purchase Fee Schedule as of 7/1/2011
- North Dakota Medicaid DME Rental Fee Schedule as of 7/1/2011
- Added and Deleted codes to the DME Fee Schedules (December 2011)
- Added and Deleted codes to the DME Fee Schedules (January 2012)
- North Dakota Medicaid DME Purchase Fee Schedule as of 07/01/2010 (1.42 MB pdf)
- North Dakota Medicaid DME Rental Fee Schedule as of 07/01/2010 (256 kb pdf)
- Added and Deleted codes to the DME Fee Schedules Effective 4-1-2011
- Revision to the Added and Deleted codes to the DME Fee Schedules Effective 4-1-2011
- Added and Deleted codes to the DME Fee Schedules Effective 4-1-2011
- ND Medicaid DME Purchase Fee Schedule effective 7-1-2009 (1.3 MB pdf)
- ND Medicaid DME Rental Fee Schedule effective 7-1-2009 (180 kb)
- Added and Deleted codes to the DME Purchase & Rental Fee Schedules effective 1-1-2010
- ND Medicaid DME Purchase Fee Schedule as of 01-01-2008 (137 kb pdf) effective 01-01-2008
- ND Medicaid DME Rental Fee Schedule as of 01-01-08 (28 kb pdf) effective 01-01-2008
- Added and Deleted codes to the DME Purchase & Rental Fee Schedules effective 2-27-2009
- Added and Deleted codes to the DME Purchase & Rental Fee Schedules effective 8-1-2008
- Added and Deleted codes to the DME Purhcase & Rental Fee Schedules effective 01-01-2008
- ND Medicaid DME Purchase Fee Schedule POSTED as of 10-20-07 (1.13 MB pdf) effective 7-1-07
- Added and Deleted codes to the DME Purhcase & Rental Fee Schedules effective 5-25-07
- ND Medicaid DME Rental Fee Schedule POSTED as of 10-20-07 (184 kb pdf) effective 7-1-0
Previous Fee Schedules
Additional Infomation
- Gait Traners (E8001 & E8002)
- Insulin Pump - Implementation Date 6/15/2011
- E0202RR: Phototherapy Light or Blanket Update effective 7-1-2010 (40kb pdf)
- ND Medicaid Policy and Procedure regarding reuse of durable medical equipment (129kb pdf)
- Meetings, Minutes and Information from the meetings
- Durable Medical Equipment (DME) Update 2-13-07
If you have questions regarding durable medical equipment or supplies, you may e-mail questions to tamholm@nd.gov or telephone (701) 328-2764. For billing questions, contact Provider Relations at (701) 328-4043.
Durable Medical Equipment Provider Forms
- Prior Authorization for Medical Equipment or Supplies Form (SFN 1115)
- Certificate of Medical Necessity - Speech Generating Device (SFN 522)
- Certificate of Medical Necessity - CPAP/BiPAP (SFN 524)
- Certificate of Medical Necessity - Standing Frames (SFN 526)
- Certificate of Medical Necessity - Infant APNEA Monitor (SFN 528)
- Certificate of Medical Necessity - Motorized Wheelchairs (SFN 720)
- Certificate of Medical Necessity - Osteogenesis Stimulators (SFN 722)
- Certificate of Medical Necessity - Seat Lift Mechanism (SFN 724)
- Certificate of Medical Necessity - Parenteral Nutrition (SFN 726)
- Certificate of Medical Necessity - Section C Continuation Form (SFN 727)
- Certificate of Medical Necessity - Support Surfaces (SFN 728)
- Certificate of Medical Necessity - Oxygen (SFN 729)
- Certificate of Medical Necessity - External Infusion Pump (SFN 780)
- Certificate of Medical Necessity - Manual Wheelchair (SFN 781)
- Certificate of Medical Necessity - Oral and/or Enteral Nutrition (SFN 782)
- Certificate of Medical Necessity - Hospital Beds (SFN 785)
- Certificate of Medical Necessity - Transcutaneous Electrical Nerve Stimulators (TENS) (SFN 789)
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