NY Manual
SHP Manual

New York Provider Manual
10.3 Pharmacy | 10.5 Home Healthcare

10.4 Durable Medical Equipment (DME), Orthotics and Prosthetics, and Medical Supplies

DME, orthotics and prosthetics are covered benefits for Healthfirst members who require such services to aid in the treatment of illness or injury or to improve bodily function. The provider must document in the member’s medical record that these items are medically necessary.

DME may be obtained through a participating DME provider with a provider’s written order and the appropriate authorization from Healthfirst.

If a member is receiving home healthcare services, DME is obtained from the home healthcare provider. This may be a hospital-owned or hospital-operated certified home health agency (CHHA) or another contracted home health agency or home infusion therapy provider. Members who are not receiving home healthcare services may be referred to or may have their provider order directly from DME and/or orthotic and prosthetic vendors that participate with Healthfirst. Healthfirst follows CMS guidelines as it relates to rental periods for all contracted providers.

DME and orthotic and prosthetic vendors must call to obtain prior authorization from Medical Management for all items.   Diabetic supplies are limited to Bayer, Healthfirst’s exclusive, preferred manufacturer.