New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 54 - PHYSICIAN SERVICES
Subchapter 5 - POLICIES AND PROCEDURES FOR PROVISION OF SERVICES PRESCRIBED OR RENDERED BY A PHYSICIAN
Section 10:54-5.30 - Medical supplies and durable medical equipment (DME) services

Universal Citation: NJ Admin Code 10:54-5.30

Current through Register Vol. 56, No. 18, September 16, 2024

(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.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.