Durable Medical Equipment (DME) refers to medical equipment or appliances that are manufactured to withstand repeated use; ordered by a physician for use in a patient’s home; and required to correct or ameliorate a patient’s disability, condition, or illness. DME includes vitamin and mineral products. DME is not typically available as a pharmacy benefit. Certain supplies and select vitamin and mineral products are a covered pharmacy benefit of Medicaid, the Children’s Health Insurance Program, the Children with Special Health Care Needs Services Program, and the Kidney Health Care Program. A pharmacy must be enrolled as a DME provider in order to provide the full array of durable medical equipment and supplies.
Pharmacies that wish to enroll as a DME provider must contact the Texas Medicaid & Healthcare Partnership (TMHP). Pharmacy staff must complete an application from the TMHP “Provider Enrollment” website to enroll.
To participate as a DME provider, pharmacies must complete the TMHP enrollment application. For assistance contact the TMHP Contact Center at 1-800-925-9126 or e-mail TMHP Provider Relations to request assistance from the local TMHP provider relations representative in your area.
All claims for DME items require a completed Title XIX Physician Order form:
- TMHP Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form (PDF)
- TMHP Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form Instructions (PDF)
For people enrolled in Medicaid managed care, pharmacies must enroll with the managed care organization (MCO) in their service area. Refer to the Pharmacy MCO Enrollment chart (PDF) for specific contact information.
Pharmacy staff can register for free computer-based trainings and webinars through the TMHP Learning Management System (LMS). This includes training modules about:
- Durable Medical Equipment (DME)
- Provider Enrollment on the Portal for Durable Medical Equipment (DME) Providers