Colorado Medicaid
Requirements -Prior Authorization Required Resources / Links PAR Instructional Reference Fee Schedule DME Manual Available Through DME Suppliers
Read More »Advanced Care Solutions
11971 NW 37TH STREET CORAL SPRINGS, FL 33065 Phone (877) 748-11987 Fax (877) 748-11985 Thickener Prescription Form Gelmix + Purathick Letter of Medical Necessity Gelmix Letter of Medical Necessity Purathick
Read More »Florida Medicaid
Favorable for Coverage: Gelmix and Purathick may be covered through DME reimbursement code B4100 (or B4100-U1) for select Florida Medicaid Managed Care plans, including Sunshine Health and CMS. Requirements – EPSDT prior authorization required (EPSDT is a Medicaid benefit that may allow coverage for medically necessary non-covered items for children under 21.) Resources / Links […]
Read More »South Carolina Medicaid
Requirements -Prior authorization may be required Resources / Links DME Provider Manual DME Fee Schedule DME 005 (Enteral Nutrition CMN) Form Available Through DME Suppliers
Read More »Massachusetts Medicaid
Requirements -Prior Authorization Required Resources / Links DME Coverage Guideline Tool Prior Authorization Request Form Available Through DME Suppliers
Read More »Michigan Medicaid
Requirements -Proof of Medical Necessity Thickening agents are covered for safe swallowing when the beneficiary has: -A diagnosis of dysphagia, and either: -A history of aspiration pneumonia -Documentation that the beneficiary is at risk of insertion of a feeding tube without the use of thickening agents for safe swallowing Resources / Links Medical Justification for […]
Read More »Wyoming Medicaid
Requirements: B4100 is considered medically necessary when prescribed by his/her medical provider and the following diagnosis applies: -Oropharyngeal dysphagia -Reflux disease -Any diagnosis that indicates child is at risk for life threatening aspiration Resources / Links Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies (DMEPOS) Manual Available Through DME Suppliers
Read More »Kentucky Medicaid
Requirements: -Prior Authorization Required: If monthly unit limits are exceeded -Unit limit: 180 ounces per calendar month -Proof of Medical Necessity Resources / Links DME Fee Schedule
Read More »Mississippi Medicaid
Favorable for Coverage: Pharmacy Benefit (OTC) Gelmix and Purathick are favorable for coverage as over-the-counter (OTC) products with a prescription under the pharmacy benefit. Click to Search Available Pharmacies Requirements -Prescription required Product NDC Codes in MS -Gelmix Infant Thickener (125g Jar): 55764-0007-02 -Gelmix Infant Thickener (2.4g Sticks): 55764-0007-11 -Purathick Natural Thickener (125g Jar): 55764-0007-10 […]
Read More »AllCare Medical Supply
Phone: 508-865-4857 Fax: 508-865-6370 30 Grafton Street Millbury, MA 01527 https://www.allcaremed.org/contact-us
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