N.J. Admin. Code § 10:54-5.30

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:54-5.30 - Medical supplies and durable medical equipment (DME) services

(a) "Medical supplies" means item(s), which are:

1. Consumable, expendable, disposable or non-durable;

2. Prescribed by the physician or practitioner (See 10:59-1.2 for further description); and

3. Medically necessary for use by a Medicaid/NJ FamilyCare program beneficiary (for example, suction catheters).

(b) "Durable medical equipment (DME)" means an item or apparatus, other than hearing aids and certain prosthetic and orthotic devices, which is:

1. Primarily and customarily used to serve a medical purpose and is medically necessary for the patient for whom it is requested; and

2. Generally not useful to a person in the absence of a disease, illness, injury, or handicap; and

3. Capable of withstanding repeated use (durable) and is non-expendable (for example, a hospital bed, oxygen equipment, wheelchair, walker, or suction equipment).

(c) Medical supplies and durable medical equipment that are essential for the patient's medical condition are allowable with the following limitations:

1. They are prescribed by a licensed practitioner and supplied by an approved Medicaid/NJ FamilyCare provider;

2. They are not reimbursable by the New Jersey Medicaid/NJ FamilyCare program when available at no charge from community resources (for example, the American Cancer Society or other service organizations); and

3. Environmental equipment, such as an air conditioner or an air filtering device, shall not be reimbursed under the New Jersey Medicaid/NJ FamilyCare program.

(d) The provider of medical supplies and durable medical equipment shall obtain prior authorization from the Medical Assistance Customer Center for the medical supplies and equipment listed in the Medical Supplier Chapter, 10:59-1.6, 1.9, and 1.10. For prior authorization for specific DME and other related services, see N.J.A.C. 10:59-2.

N.J. Admin. Code § 10:54-5.30

Amended by R.2001 d.51, effective 2/5/2001.
See: 32 N.J.R. 3929(a), 33 N.J.R. 555(a).
In (a)3, substituted "beneficiary" for "recipient" preceding "for example,"; in (d), substituted "Medical Assistance Customer Center" for "Medicaid District Office" preceding "for the medical supplies".
Amended by R.2012 d.124, effective 7/2/2012.
See: 43 N.J.R. 1477(a), 44 N.J.R. 1884(a).
In the introductory paragraph of (a), inserted a comma preceding "which"; in (a)3, inserted "/NJ FamilyCare program"; in (c)1, (c)2 and (c)3, inserted "/NJ FamilyCare"; in (c)2, deleted a comma following "Society"; and in (c)3, inserted a comma following "equipment".