This program describes our procedure for the prescription of durable medical equipment (DME). DME coverage is subject to the member’s benefit plan. Members may be responsible for paying a portion of the DME’s cost in the form of a copay/coinsurance and/or deductible. The DME provider will notify the member when copays/coinsurance and/or deductibles are due.
Preauthorization may be needed before certain services can be rendered or equipment supplied. Depending on which networks members access and who has financial risk for their care, preauthorization requests are evaluated by either the DME vendor (eviCore), EmblemHealth, or a Managing Entity. For the list of Healthcare Common Procedure Coding System (HCPCS) codes requiring preauthorization, refer to Clinical Corner.
DME must be ordered from a contracted DME provider. Most DME providers will work with your office to complete the preauthorization request (including the applicable forms). To locate an appropriate DME provider in your area, visit emblemhealth.com/find-a-doctor.