Vermont Medicaid Durable Medical Equipment (DME) …

Vermont Medicaid Durable Medical Equipment (DME) Restrictions Updated 01/16/2019. The following list of codes is provided for reference purposes only and may not be all inclusive. Listing of a code does not imply that the service described by the code is a covered or non-covered health service. Please refer to the Fee Schedule for coverage. Prior authorization is required for items in excess of the limits when medically necessary. Codes included in the capped rental program will be followed by an asterick * and are paid in 10 monthly installments HCPCS DESCRIPTION UNIT EQUALS LIMIT.

hcpcs code description unit equals limit a4206 syringe with needle, sterile 1 cc or less, each one syringe w/needle 100 per 30 days a4224 supplies for maintenance of insulin infusion catheter, per week 1 per week 4 per calendar

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  Medical, Equipment, Durable, Durable medical equipment

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