Durable Medical Equipment (DME)
The DME items for which UnitedHealthcare requires preauthorization include the list below. Other items requiring preauthorization are listed under Procedures, Drugs, and Other Services.
Note: The benefits on the pages below DO NOT apply to TennCare. Please call 1-800-690-1606 for TennCare preauthorization information.
DME requiring preauthorization:
- Air fluidized beds (Pressure Reducing Support Surfaces - Group 3)
- Alternating Pressure Mattresses and Low-Air Loss Mattresses (Pressure Reducing Support Surfaces - Group 2)
- Augmentive Communicator Device / Speech Generating Device
- Bone Growth Stimulators
- Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes
- Cranial Orthosis for Positional Plagiocephaly and Craniosynostosis
- Custom Fabricated Wheelchair Cushions (E2609 and E2617)
- Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation
- Elemental Formulas for Eosinophilic Disorder or Short Bowel Syndrome (Illinois ONLY)
- High Frequency Chest Wall Compression
- Hospital Beds (semi-electrical and electrical)
- Mechanical Stretching (Dynasplint) and Continuous Passive Motion Devices (E0936-other than knee)
- Power Mobility Assistive Equipment (Scooter/Power-Operated Vehicle, Power Wheelchair)
- Power Tilt in Space Wheelchairs and Reclining Wheelchairs
- Pressure Reducing Support Surfaces - Group 1 (e.g., Overlays, Pads)
- Seat Lift Mechanisms (lift chair)
- Specialized, Microprocessor or Myoelectric Limbs
- UVB Light Cabinet for Home Phototherapy
Questions regarding coverage for DME can be directed to a UnitedHealthcare Customer Service Representative. Please have the description of the item available when calling. The Customer Service Representative will tell you if the DME item requires preauthorization. The representative can also inform you of provider and member eligibility and/or coverage of specific DME items.
An orthotic device such as braces for the leg, arm, or back, is an orthopedic appliance used to support, align, or correct deformities or to improve the function of a movable part of the body. Orthotic devices are only covered by UnitedHealthcare when included in the benefit plans and when medically indicated. Please verify your benefits in your plan documents for actual orthotic coverage.
Prosthetic devices such as artificial legs, arms, and eyes, are artificial substitutes for a missing body part. Prosthetic devices are covered by UnitedHealthcare when medically indicated, but may be subject to benefit limits.
UnitedHealthcare reserves the right to change this list at any time without notice. UnitedHealthcare does not guarantee that this list is complete or current. Contact a UnitedHealthcare Customer Service Representative to discuss your health plan's requirements.