Question 1

Does Medicaid cover durable medical equipment in New York City?

Accepted Answer

Yes. All DME we supply is covered by Medicaid or HMO plans when there is a patient physician prescription and the item meets medical-necessity criteria. New York City Medicaid coverage is governed primarily by the New York State Medicaid DMEPOS Manual, and NYS updated the DME provider manuals effective July 1, 2026.

Question 2

What about Medicaid Managed Care and HMO plans?

Accepted Answer

Medicaid Managed Care plans generally cover DME as a benefit, but the billing destination, prior authorization requirements, network rules and reimbursement can vary by item and by plan. We verify your specific plan before we order anything, so there are no surprise bills.

Question 3

Do I need a prescription?

Accepted Answer

Yes. Every covered item requires a prescription (and for many items, supporting documentation) from your treating physician. Send us the prescription and we take it from there — you can fax it, email it, or have the office send it directly.

Question 4

Who handles the prior authorization?

Accepted Answer

We do. Our team prepares the prior-authorization packet, assembles the medical-necessity documentation, submits it to Medicaid or your HMO, follows up on the determination and gets it approved. You do not need to chase the plan yourself.

Question 5

How long does prior authorization take?

Accepted Answer

Simple items are often approved within a few business days; complex rehab equipment such as custom power wheelchairs can take longer because plans require an evaluation and additional documentation. We keep you updated at each step and can supply loaner or interim equipment where allowed.

Question 6

What if my item is denied?

Accepted Answer

A denial is usually a documentation issue, not a final answer. We review the denial reason, gather the additional clinical justification from your physician and resubmit or appeal on your behalf.

Question 7

What will I pay out of pocket?

Accepted Answer

For covered items with an approved authorization, Medicaid patients typically have no out-of-pocket cost. HMO and commercial plans may apply a copay, coinsurance or deductible; we confirm your responsibility in writing before we deliver.

Question 8

How do you confirm coverage criteria and codes?

Accepted Answer

We check current HCPCS codes, coverage criteria and fees against the official NYS eMedNY DME Manual, so the claim matches what your plan expects.

Durable medical equipment, fitted to the person using it

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Medicaid, HMO & prior authorization questions

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