Entire DMS Handbook — PDF (414 KB)
Cover Memo Letter — PDF (23 KB)
Important Telephone Numbers — PDF (13 KB)
Table of Contents — PDF (12 KB)
General Information Section — PDF (32 KB)
Covered Services Section — PDF (28 KB)
Prior Authorization Section — PDF (25 KB)
Claims Submission — PDF (25 KB)
Appendix (Entire Section — PDF)
Appendix 1 (PDF, 28 KB) — CMS 1500 Claim Form Completion Instructions for Disposable Medical Supplies
Appendix 2 (PDF, 79 KB) — Completed Sample CMS 1500 Claim Form for Disposable Medical Supplies
Appendix 3 (PDF, 13 KB) — Description of Exceptional Supplies —
Appendix 4 (PDF, 25 KB) — Key to Reading the Disposable Medical Supplies
Appendix 5 (PDF, 20 KB) — Prior Authorization Request Form (PA/RF) Instructions for Disposable Medical Supplies
Appendix 6 (PDF, 45 KB) — Completed Sample Prior Authorization Request Form (PA/RF)
Appendix 7 (PDF, 20 KB) — Completed Sample Prior Authorization Request Form (PA/RF), Prior Approval Granted
Appendix 8 (PDF, 44 KB) — Completed Sample Prior Authorization Request Form (PA/RF) for Exceptional Supplies
Appendix 9 (PDF, 46 KB) — Completed Sample Prior Authorization Request Form (PA/RF) for Exceptional Supplies, Prior Approval Granted
Appendix 10 (Revised PDF, 23 KB) — Prior Authorization Durable Medical Equipment Attachment (PA/DMEA) Completion Instructions
Appendix 11 (PDF, 22 KB) — Sample Completed Prior Authorization Durable Medical Equipment Attachment (PA/DMEA)
Appendix 12 (Revised PDF, 141 KB) — Prior Authorization Durable Medical Equipment Attachment (PA/DMEA) (for photocopying)
Glossary — PDF, 21 KB
Index — PDF, 12 KB