MedicaidPrior AuthMedium impact
DC Medicaid: DME prior authorization update
UnitedHealthcare·DC · PM&R (Physical Medicine & Rehab), Physical Therapy, Occupational Therapy +1 more·State news
Effective date
Oct 1, 2025
We identified it
Jan 12, 2026
Summary
Effective October 1, 2025, UnitedHealthcare DC Medicaid is aligning specific durable medical equipment (DME) prior authorization requirements with their Dual Complete Special Needs Plan requirements. This affects hospital beds, patient lifts, power wheelchairs, and respiratory support devices for DC Medicaid and integrated DSNP LTSS enrollees.
Action Required
By October 1, 2025: Billing team must update prior authorization workflows for DME categories including hospital beds, patient lifts, power wheelchairs, and respiratory support devices for DC Medicaid patients. Review the updated CPT code list (modified September 22, 2025) and ensure prior authorization is obtained through the UnitedHealthcare Provider Portal before submitting claims for these DME items.