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(e) Medical supplies billed using a miscellaneous Health Care Financing Procedure Coding System (HCPCS) code are required to have a copy of the invoice submitted for the equipment billed. Payment for medical supplies will be based on the invoice amount plus a negotiated percentage amount.

(f) Medicare’s criteria is followed for the coverage of medical supplies unless specifically stated elsewhere. This provision also applies to the maintenance, replacement, and repair of medical supplies. [Eff 08/01/94; am 02/16/02; am 05/10/03; am 09/17/07 ] (Auth: HRS §346-14) (Imp: 42 C.F.R. §§440.20, 440.90)

§17-1737-74 Prosthetic and orthotic appliances. (a) Prosthetic and orthotic appliances means those appliances prescribed by a physician, dentist, or podiatrist for the restoration of function or replacement of functional body parts.

(b) Prior authorization shall be required when the original or cumulative cost for purchase, repair, or manufacture of the appliances exceeds $50, except for dental prosthetic appliances which are covered under section 17-1737-75.

(c) The following items may be covered by the medical assistance program: (1) Stock prosthetic eyes to prevent the problems associated with an empty eye socket; (2) Orthopedic and therapeutic shoes when prescribed by a physician and provided by a prosthetist or an orthotist and when at least one of the shoes will be attached to a brace or prosthesis or the individual is diabetic; (3) Stock orthopedic shoes and high-topped shoes for children under the age of six years; (4) Modification of stock conventional or orthopedic shoes when medically necessary; (5) Custom-made orthopedic shoes when there is a clearly established medical need that cannot be satisfied by the modification of stock conventional or orthopedic shoes; and