Georgia Medicaid DME (2026): Wheelchairs, Oxygen, CPAP, Hospital Beds, PA Tiers, Repair, Replacement, EPSDT Children

Lead: Durable medical equipment is one of the most heavily utilized Medicaid benefits in Georgia and also one of the most procedurally demanding. The benefit covers far more than members usually realize, wheelchairs from a standard walker to a custom power chair, oxygen and CPAP, hospital beds, lift equipment, incontinence and ostomy supplies, prosthetics, orthotics, AAC communication devices, diabetic supplies, and dozens of categories besides. But coverage rests on documentation: face-to-face encounters for specified items, ATP evaluations for complex mobility, sleep studies for CPAP, ABG results for oxygen, letters of medical necessity, prior authorization, and home assessments. When the paperwork is in order, claims pay. When it is not, members wait months for the equipment they need, or pay out of pocket and lose access to appeal.

This guide walks through Georgia Medicaid DME coverage in 2026: what is covered (and what is not), the federal authorities behind the benefit, the four-part test for DME, the major equipment categories and their specific requirements, the face-to-face encounter rule, the three-tier prior authorization framework, the reasonable useful lifetime standard, rental versus purchase categories including capped-rental rules, the EPSDT pediatric expansion that opens specialty pediatric equipment to children under twenty-one, Medicare and Medicaid coordination for dual eligibles including the Atlanta Competitive Bidding Program, repair and replacement rules, six worked examples ranging from a child's first power wheelchair to a Type 1 diabetic insulin pump, fifteen common mistakes that lead to denied claims, a ten-question FAQ, and a complete contact list of major DME suppliers and resources.

This is the canonical Georgia Medicaid DME playbook.

By Brevy Care Team · Last verified May 12, 2026

What counts as durable medical equipment

Georgia Medicaid covers DME that meets a four-part federal test, consistent with the federal definition and parallel Medicare standards.

To qualify as DME, an item must be:

1. Durable. Able to withstand repeated use over time.
2. Used for a medical purpose. Primarily and customarily used to serve a medical purpose.
3. Not useful in the absence of illness or injury. Not generally useful to a person who is not ill or injured.
4. Appropriate for use in the home. Suitable for use in the patient's place of residence.

Equipment that meets all four criteria is potentially covered, subject to medical necessity, prior authorization, and the specific coverage rules detailed in this guide. Equipment that fails any of the four (a lift chair without medical necessity documentation, a household appliance, equipment usable only in hospital or clinic settings) is generally not covered.

DME is delivered to Georgia Medicaid members through Medicaid-enrolled DME suppliers. Coverage is administered by the Georgia Families Care Management Organizations (CMOs) for managed care enrollees and by DCH directly for fee-for-service Medicaid. DME is not carved out from CMO capitation in Georgia.

Major DME categories covered

Georgia Medicaid's DME benefit is broad. The major categories and what each includes are described below.

Mobility equipment

The mobility category includes the full continuum from simple ambulation aids to complex power mobility.

Manual wheelchairs. Standard manual wheelchairs (basic models, weighing thirty-five pounds or more) are widely available. Lightweight manual wheelchairs (twenty-five to thirty-four pounds) are covered with appropriate justification for full-time users. Ultra-lightweight (under twenty-five pounds) and titanium frame chairs require comprehensive documentation including the shoulder preservation rationale for long-term wheelchair users. Tilt-in-space manual wheelchairs are covered for members with pressure relief and posture management needs.

Power wheelchairs. Power wheelchairs are categorized by CMS into Groups 1 through 5. Group 1 standard power wheelchairs are for indoor use. Group 2 covers more advanced models. Group 3 (the most commonly authorized for full-time users) includes powered tilt, recline, and elevating leg rest options. Groups 4 and 5 are highly specialized for complex rehabilitation needs.

Scooters. Power-operated vehicles (scooters) are covered but the bar is higher than for power wheelchairs. Members must demonstrate functional mobility need that cannot be met by a less expensive walker or manual chair but also do not require the more comprehensive support a power wheelchair provides.

Wheelchair accessories. Cushions (foam, gel, air, ROHO), seat backs, headrests, lap belts, anti-tippers, leg rests, and arm rests are covered with the parent wheelchair purchase and replaceable during the useful lifetime.

Repairs. Wheelchair repairs are covered during the reasonable useful lifetime when cost-effective compared to replacement.

Walkers. Standard walkers, wheeled walkers, and rollators (walkers with wheels, brakes, and seats) are all covered. Standard walkers typically do not require prior authorization.

Canes and crutches. Single-point canes, quad canes, forearm crutches, and axillary crutches are covered without prior authorization in most cases.

Patient lifts. Manual Hoyer-type lifts and power patient lifts are covered for members requiring two-person or mechanical transfers. The lift, sling, and replacement slings are all covered.

Respiratory equipment

Respiratory equipment is one of the most utilized DME categories, particularly for members with COPD, sleep apnea, and chronic ventilatory failure.

Oxygen therapy. Stationary oxygen concentrators for home use and portable cylinders for ambulation are both covered. Coverage requires documentation of qualifying arterial blood gas results or pulse oximetry, or alternative criteria for exercise-related or sleep-related desaturation. The Certificate of Medical Necessity (CMS-484) signed by the prescribing physician is required.

CPAP and BiPAP. Continuous positive airway pressure machines and bilevel positive airway pressure machines are covered for obstructive sleep apnea documented by polysomnogram or home sleep apnea test. Coverage during the first ninety days requires demonstrated regular use meeting the CMO-specified compliance threshold.

Nebulizers. Compressor-driven nebulizers and disposable nebulizer accessories are covered for members requiring inhaled medications.

Ventilators. Volume-cycled, pressure-cycled, and bilevel-with-backup-rate ventilators are covered for chronic ventilatory failure and for technology-dependent children under EPSDT.

Tracheostomy supplies. Inner cannulas, outer cannulas, ties, and suction supplies are covered for members with tracheostomies.

Cough assist devices. Mechanical insufflation-exsufflation devices (CoughAssist) are covered for members with neuromuscular conditions affecting cough.

Beds and positioning

Hospital beds. Semi-electric, fully electric, and total electric hospital beds are covered for members with documented medical need including limited mobility, swallowing precautions requiring head elevation, fall risk, pressure ulcer risk, or pulmonary conditions requiring positioning.

Mattresses. Standard hospital bed mattresses are covered with the bed. Pressure-reducing mattresses for ulcer prevention, alternating pressure mattresses for ulcer treatment, and low-air-loss mattresses for advanced wound care are covered with medical necessity documentation.

Bedside commodes. Standard commodes and drop-arm commodes are covered for members with toileting difficulties.

Diabetic supplies

The diabetic supply category includes both routine testing and advanced monitoring technology.

Glucose meters and test strips. Standard glucose meters, test strips, lancets, and lancing devices are covered for all diabetic members.

Continuous glucose monitors. Dexcom and Freestyle Libre CGMs are covered with prior authorization, typically for Type 1 diabetics or Type 2 diabetics on intensive insulin therapy. Sensors are covered as monthly supplies.

Insulin pumps. Tandem t:slim, Omnipod, and Medtronic insulin pumps are covered with prior authorization for members meeting clinical criteria (Type 1 diabetes, suboptimal control on multiple daily injections, demonstrated motivation and capability for pump management).

Incontinence supplies

Incontinence supplies, including adult diapers, briefs, pull-ups, underpads, and skin barrier products, are covered for members with documented medical need. Contact your CMO for specific coverage criteria and utilization limits.

Ostomy supplies

Ostomy bags and pouches, wafers and flanges, skin barriers, adhesive removers, stoma powder, and belts are covered for members with colostomies, ileostomies, and urostomies.

Wound care supplies

Gauze, dressings, compression bandages, and negative pressure wound therapy (Wound VAC) equipment and supplies are covered for members with wounds requiring active management.

Enteral and parenteral nutrition

Tube feeding pumps and supplies, enteral formulas with prior authorization for some products, IV pumps and poles, and parenteral nutrition supplies are covered for members requiring nutritional support.

Orthotics and prosthetics

Custom-molded foot orthotics, ankle-foot orthoses (AFOs), knee-ankle-foot orthoses (KAFOs), spinal orthoses (TLSO, LSO), and cervical collars are all covered with prescribing orders and medical necessity documentation. Lower and upper extremity prosthetics, including sockets, liners, sleeves, and component parts, are covered for members with amputations.

Other DME

Compression stockings, apnea monitors, phototherapy equipment, augmentative and alternative communication devices, and standers for children with developmental disabilities are all covered when medically necessary.

What's not covered

Several categories are routinely denied or excluded.

Personal convenience items. Televisions, telephones, lift chairs without medical justification, and other comfort items are not DME.

Home modifications. Stair lifts, bathroom modifications, doorway widening, and ramps are home modifications. They may be covered under HCBS waivers (CCSP, ICWP) for waiver participants but are not state plan DME.

Routine appliances. Air conditioners, dehumidifiers, air purifiers, and whirlpool baths are generally not covered absent extraordinary medical necessity documentation.

Vehicle modifications. Wheelchair-accessible vans, lifts, and ramps are not state plan DME. Some HCBS waivers cover vehicle modifications for participants.

Stairs lifts specifically. Stair lifts are routinely denied as home modifications even when medical need is clear. Members requiring stair access should explore HCBS waiver options or family financing.

The face-to-face encounter requirement for DME

Federal law requires physicians ordering certain Medicare and Medicaid items to conduct an in-person face-to-face encounter with the patient documenting the medical necessity for the item.

Which DME requires F2F

The F2F encounter requirement applies to "specified covered items of DME," which CMS has defined to include:

• Power mobility devices (power wheelchairs and scooters)
• Oxygen therapy
• Hospital beds and accessories
• Other items on the CMS specified-item list

Standard manual wheelchairs, walkers, canes, and most routine supplies do not require F2F under federal law.

F2F rules

The face-to-face encounter must:

1. Be performed by the prescribing physician, or by a nurse practitioner, clinical nurse specialist, certified nurse midwife, or physician assistant working with the prescribing physician
2. Occur no more than six months before the order
3. Be related to the primary reason for the equipment
4. Document the medical necessity for the specific item ordered

Without compliant F2F documentation, the DME supplier cannot bill Medicaid for specified items. This is one of the most common reasons for claim denials.

The three-tier prior authorization framework

Georgia Medicaid DME follows a three-tier PA structure based on item cost, complexity, and abuse potential.

Tier 1: no prior authorization

Low-cost, routine supplies and basic equipment generally do not require PA:

• Standard walkers, canes, and crutches
• Routine incontinence supplies within monthly caps
• Ostomy supplies
• Standard diabetic supplies (meter, strips, lancets)
• Routine medical supplies for home health care

Tier 2: streamlined prior authorization

Mid-cost equipment with relatively standardized criteria:

• Manual wheelchairs (standard)
• Standard hospital beds
• Oxygen concentrators with supporting documentation
• CPAP machines with sleep study and physician order
• Standard nebulizers

Tier 3: full prior authorization with detailed medical necessity documentation

High-cost, complex, or specialty equipment requires comprehensive PA submissions:

• Power wheelchairs (Group 2 and above)
• Custom-fitted manual wheelchairs (tilt-in-space, ultra-lightweight, complex rehab)
• Specialty mattresses for ulcer treatment
• Custom seating systems
• AAC devices
• Custom prosthetics and orthotics
• Continuous glucose monitors and insulin pumps
• Bariatric equipment
• Wound VAC equipment
• Bilevel BiPAP with backup rate, ventilators
• Complex rehabilitation technology

PA decision timing

Standard PA decisions are issued within the DCH- or CMO-specified turnaround period after complete submission. Expedited PA, when a delay would jeopardize the member's health, must be decided on an accelerated timeline. Continued PA review (renewals) follows the same timing.

Required documentation for high-tier PA

The documentation required for a power wheelchair PA is representative of high-tier requirements:

1. Comprehensive PT or OT evaluation conducted by an Assistive Technology Professional (ATP)
2. Physician's detailed written order specifying make, model, and components
3. Face-to-face encounter documentation
4. Functional mobility assessment showing inability to safely or efficiently use less expensive mobility equipment
5. Home assessment confirming the wheelchair will fit through doorways and maneuver in the home environment
6. Trial of less expensive equipment (cane, walker, manual wheelchair) and documentation of insufficiency
7. ATP-certified supplier delivery and fitting
8. Letter of medical necessity from the prescribing physician

For oxygen, PA typically requires qualifying arterial blood gas results or pulse oximetry, the physician's Certificate of Medical Necessity (CMS-484), and recent diagnosis documentation.

For CPAP, PA typically requires a polysomnogram or home sleep apnea test documenting obstructive sleep apnea, the physician's order, and after the first ninety days, documented compliance with the CMO-specified usage threshold.

The reasonable useful lifetime

Medicare and Medicaid generally apply a Reasonable Useful Lifetime (RUL) standard to most DME, though specific items have different RULs. Contact your CMO or DCH for the RUL applicable to a specific item.

Common RUL standards

• Manual wheelchairs: standard RUL per DCH policy
• Power wheelchairs: standard RUL per DCH policy
• Hospital beds: standard RUL per DCH policy (some categories longer)
• CPAP machines: standard RUL per DCH policy
• Mattresses: standard RUL per DCH policy
• Walkers: standard RUL per DCH policy
• Patient lifts: standard RUL per DCH policy
• Glucose meters: standard RUL per DCH policy

What happens at end of RUL

Members are eligible for replacement equipment if medical necessity continues. Documentation must include continued need and an assessment that the current equipment cannot be repaired or no longer functions adequately. Replacement requires a fresh PA submission with full medical necessity documentation. Equipment is not automatically replaced; the member or supplier must affirmatively request it.

Repairs

Repairs are covered when needed to keep equipment functional during the RUL. The repair must be cost-effective compared to replacement. PA is required for repairs above the threshold specified by DCH or the CMO. Routine wear-and-tear repairs are generally covered without PA up to limits. Same-day or expedited service should be available for urgent repairs (a wheelchair breakdown for a full-time user, oxygen equipment failure).

Rental versus purchase

Some DME is provided through rental, others through purchase, and a third category goes through "capped rental" where rental payments accumulate until ownership transfers.

Rental categories

• Oxygen equipment: capped rental period under Medicare, generally followed by Medicaid
• Hospital beds: capped rental until ownership transfers
• CPAP machines: similar capped rental-to-purchase model
• Negative pressure wound therapy (Wound VAC): pure rental, billed monthly during use
• Most power wheelchairs: typically purchase from day one
• Some custom equipment: purchase from day one

Capped rental rules

For capped rental items, monthly rental payments are made until the cap is reached. At that point, ownership transfers to the patient. After ownership, the patient is responsible for routine maintenance, though most major repairs remain Medicaid-covered.

EPSDT pediatric DME expansion

Children under twenty-one receive significantly broader DME coverage than adults through the federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) mandate. The "correct or ameliorate" standard requires Georgia Medicaid to cover any DME that is medically necessary to correct or ameliorate a condition identified through EPSDT screening, even if not covered for adults.

Common EPSDT-expanded DME categories

• Specialty pediatric wheelchairs (Convaid, Kid-Cart, R82, Quickie Iris pediatric)
• Specialty pediatric strollers (Convaid Cruiser, Special Tomato)
• Pediatric standers and gait trainers (Rifton, Leckey, Snug Seat)
• Augmentative and alternative communication devices for children with autism, cerebral palsy, or complex communication needs
• Adaptive bath equipment (bath chairs, shower commodes for pediatric users)
• Adaptive feeding equipment (specialty cups, bowls, utensils)
• Hospital beds for medically complex children
• Apnea monitors for premature infants
• Phototherapy equipment for jaundice in newborns
• Custom orthotics for children with cerebral palsy, spina bifida, or clubfoot
• Pediatric oxygen and ventilator equipment

EPSDT children still go through prior authorization, but standards are interpreted more broadly to support development, function, and rehabilitation. The "correct or ameliorate" standard is materially broader than the adult medical necessity test.

Dual eligibles and DME

For adults dually eligible for Medicare and Medicaid, Medicare Part B is primary for DME.

Medicare DME as primary

Medicare pays a portion of allowed charges after the Part B deductible, and the member is responsible for the Part B coinsurance. For dual eligibles with Qualified Medicare Beneficiary (QMB) status under a Medicare Savings Program, Medicaid pays the Part B coinsurance. For other dual eligibles, the member may be responsible for coinsurance depending on their MSP category.

Medicare DMEPOS Competitive Bidding

Medicare implemented competitive bidding for certain DMEPOS items in selected areas. The Atlanta metro area is a Competitive Bidding Program area. Suppliers must be Medicare CBP contract suppliers to provide bid-category items in CBP areas. The supplier network is significantly narrower in CBP areas than in non-CBP areas.

Common competitive bidding categories include oxygen, CPAP and respiratory assist devices, hospital beds, standard manual wheelchairs, and some power wheelchair categories.

Medicaid wraparound

Medicaid covers DME for dual eligibles when:

1. Medicare denies (item not covered or not medically necessary by Medicare standards)
2. Medicare benefit is exhausted (past the oxygen rental cap)
3. The item is not Medicare-covered but is Medicaid-covered
4. Medicaid coverage is broader (incontinence supplies, for example, are generally not Medicare-covered but are Medicaid-covered)

Six worked examples

The procedural framework comes alive in specific cases.

Example 1: Sarah Williams, 9, cerebral palsy and first power wheelchair

Sarah, age nine, has spastic quadriplegic cerebral palsy. She has outgrown her current manual wheelchair and needs her first power wheelchair.

Coverage pathway:

1. Sarah's developmental pediatrician at Children's Healthcare of Atlanta refers her to Numotion for an ATP evaluation.
2. The ATP-certified specialist conducts a comprehensive evaluation with PT and OT (ninety-minute appointment).
3. Power mobility evaluation determines Sarah can safely operate the joystick and tilt controls.
4. Home assessment confirms the wheelchair will fit through doorways and maneuver in the family's home.
5. The physiatrist provides a letter of medical necessity documenting quadriplegic CP at GMFCS Level IV, inability to functionally ambulate, inability to self-propel a manual wheelchair due to upper extremity involvement, need for tilt-in-space for pressure relief and posture management, and need for power mobility for school, community, and home function.
6. The physiatrist conducts the face-to-face encounter documentation.
7. PA is submitted to the CMO with comprehensive documentation.
8. PA is approved for a Group 3 power wheelchair with tilt-in-space (HCPCS K0856).
9. National Seating & Mobility delivers and fits the chair, including a comprehensive seating evaluation.
10. The wheelchair is Sarah's. Medicaid will cover repairs and accessories for the RUL period.

Cost to Sarah's family: $0 (EPSDT, no cost-sharing for children under twenty-one).

Example 2: Marcus Brown, 58, COPD and home oxygen

Marcus, age fifty-eight, has severe COPD. His pulmonologist orders home oxygen therapy at two liters per minute continuous.

Coverage pathway:

1. The pulmonologist conducts the face-to-face encounter at the office visit.
2. An arterial blood gas drawn at the office shows qualifying oxygen saturation levels on room air, meeting the coverage threshold.
3. The pulmonologist signs the Certificate of Medical Necessity (CMS-484) for oxygen.
4. The CMN is sent to Apria Healthcare, a Medicare CBP contract supplier in the Atlanta CBP area.
5. PA is submitted; approved within seven business days.
6. Apria delivers a stationary oxygen concentrator for the home and portable cylinders for ambulation.
7. The capped rental period begins.
8. Monthly tank refills are provided as needed.
9. After the capped rental period ends, the supplier owns the equipment but Marcus retains use as long as his medical need continues.
10. Equipment maintenance and service continue as part of the supplier relationship.

Cost to Marcus: Medicare primary with Part B coinsurance; if Marcus has QMB status, Medicaid pays the coinsurance and he has zero out-of-pocket.

Example 3: Frances Carter, 78, post-stroke hospital bed

Frances, age seventy-eight, had a stroke six months ago. She has chronic right hemiparesis and is bed-bound much of the day. Her PCP orders a fully electric hospital bed for her home.

Coverage pathway:

1. The PCP conducts the face-to-face encounter.
2. Medical necessity documentation includes hemiparesis requiring assisted positioning, swallowing precautions requiring head-of-bed elevation, fall risk on a standard bed, and caregiver back injury limiting ability to operate manual crank for adjustment.
3. The order specifies fully electric hospital bed (HCPCS E0297) with side rails.
4. Apria submits the PA to CareSource.
5. PA is initially approved for semi-electric; on resubmission with caregiver injury documentation, the upgrade to full electric is approved.
6. The bed is delivered within five business days.
7. The initial capped rental period begins.
8. After the capped rental period, ownership transfers to Frances.
9. Medicaid continues to cover repairs and replacement parts.

Cost to Frances: $0 (full Medicaid coverage; if Frances is a QMB dual, Medicare primary with Medicaid paying Part B coinsurance).

Example 4: Tyler Johnson, 16, Type 1 diabetes and CGM with insulin pump

Tyler, age sixteen, has Type 1 diabetes. His endocrinologist recommends transition to continuous glucose monitor (Dexcom G7) and insulin pump (Tandem t:slim).

Coverage pathway:

1. The endocrinologist documents Type 1 diabetes with multiple daily injections regimen, HbA1c trend showing inadequate control, hypoglycemia awareness status, patient and family motivation and capability to manage pump, and completion of comprehensive diabetes education.
2. The face-to-face encounter is documented.
3. PA is submitted for the CGM (HCPCS A4239) and the insulin pump (HCPCS E0784).
4. Tandem Diabetes Care submits the pump application.
5. PA is approved for both CGM and pump under EPSDT principles expanding access for children.
6. Tyler is trained on the pump and CGM by a certified diabetes educator.
7. Pump supplies (infusion sets, reservoirs) are approved monthly through the pharmacy benefit (Gainwell SPBM).
8. CGM sensors are approved monthly through the DME supplier.
9. Reauthorization every six months with HbA1c and utilization data.

Cost to the Johnson family: $0 (EPSDT).

Example 5: Wallace Brown, 84, fall risk and walker

Wallace, age eighty-four, has had two falls in the past month at his apartment. His PCP recommends a rollator with seat for community ambulation.

Coverage pathway:

1. The PCP visits Wallace and documents the F2F (not strictly required for a walker but documents fall risk and need).
2. The order specifies a wheeled walker with seat and basket (HCPCS E0143).
3. No prior authorization is required (Tier 1, low-cost standard walker).
4. The local independent DME supplier delivers the walker within three days.
5. A PT consultation is arranged through home health (separate referral) for gait training.
6. The walker is Wallace's. Replacement is available at end of the RUL period or sooner with documentation of need.

Cost to Wallace: $0 (dual eligible with QMB; Medicare primary, Medicaid pays Part B coinsurance).

Example 6: Maria Lopez, 35, T6 paraplegia and complex wheelchair replacement

Maria, age thirty-five, has T6 paraplegia from a spinal cord injury twelve years ago. Her current ultra-lightweight manual wheelchair is six years old (past RUL) and showing significant wear. She needs a replacement.

Coverage pathway:

1. Comprehensive PT and OT ATP evaluation at Shepherd Center (the Atlanta SCI rehabilitation specialty hospital).
2. Face-to-face encounter with the physiatrist.
3. Letter of medical necessity documents T6 paraplegia with full-time wheelchair use, current wheelchair past RUL with frame damage, need for ultra-lightweight (under twenty-five pounds) for self-propulsion and shoulder preservation, and need for specific seating system to prevent skin breakdown given history of Stage II pressure ulcer.
4. Specifications include titanium frame, custom cushion (ROHO), backrest, and push-rim ergonomic handrims.
5. National Seating & Mobility ATP completes the order specifications.
6. PA is submitted to Wellcare with full documentation.
7. Initial denial cites "frame material could be aluminum."
8. Appeal is filed with Shepherd Center support and documentation of the shoulder preservation rationale (titanium is substantially lighter than aluminum, materially reducing repetitive strain on shoulders).
9. PA is approved on appeal.
10. The new wheelchair is delivered six weeks after the initial evaluation.

Cost to Maria: $0 (SSI Medicaid full coverage).

Fifteen common mistakes

1. Skipping the face-to-face encounter for specified items. Power wheelchairs, oxygen, hospital beds, and other specified items require F2F. Without compliant F2F documentation, the claim will not pay.

2. Buying DME without prior authorization. Most Tier 2 and Tier 3 DME requires PA before delivery. Buying out of pocket and seeking reimbursement is generally not allowed.

3. Confusing DME with home modifications. Stair lifts, bathroom modifications, doorway widening, and ramps are home modifications. They may be covered under HCBS waivers (CCSP, ICWP) for waiver participants but NOT under the DME state plan benefit.

4. Not getting an ATP evaluation for complex mobility. Power wheelchairs and complex manual wheelchairs require evaluation by an Assistive Technology Professional. Primary care physicians cannot prescribe complex rehab technology without ATP involvement.

5. Skipping the home assessment. Wheelchairs that do not fit through doorways or maneuver in the home will fail at delivery. Home assessment by ATP should occur before the order is finalized.

6. Not tracking the RUL. Equipment is eligible for replacement at end of the RUL period. Replacing earlier requires documentation of why current equipment cannot be repaired or no longer functions.

7. Letting CPAP utilization drop below threshold. Medicare requires (and Medicaid follows) demonstrated regular use meeting the compliance threshold during the first ninety days. Failure to meet the threshold means CPAP coverage ends.

8. Not knowing about EPSDT expansion. Children under twenty-one can receive DME categories that adults cannot. Specialty pediatric strollers, gait trainers, standers, AAC devices, and adaptive equipment are routinely approved under EPSDT.

9. Going to non-Medicare-certified suppliers in the Atlanta CBP area. Only Medicare CBP contract suppliers can provide bid-category items in CBP areas. Members must use a contracted supplier or face out-of-pocket cost.

10. Skipping the appeal of an initial denial. Many DME denials are reversed on appeal with proper documentation. Do not accept the first denial; appeal with a comprehensive letter of medical necessity.

11. Trying to upgrade DME without PA justification. Choosing an upgraded model (titanium versus aluminum wheelchair, full electric versus semi-electric bed) typically requires PA documentation of medical necessity for the upgrade.

12. Not coordinating DME with home health services. Equipment delivered alongside home health should be coordinated through the home health agency to ensure proper setup, fitting, and patient training.

13. Forgetting to update suppliers when changing coverage. If you switch from fee-for-service Medicaid to a CMO (or between CMOs), notify your DME suppliers immediately so they can update billing.

14. Discarding broken equipment instead of pursuing repair. Most DME repairs are covered. Call the supplier first; they coordinate PA for repairs above thresholds.

15. Letting a Medicare denial end the analysis for dual eligibles. Medicaid may cover DME that Medicare denies. Pursue both Medicare appeal and direct Medicaid coverage analysis.

A note on accuracy

This guide reflects Georgia Medicaid DME coverage as it stands in 2026. CMS policy, prior authorization criteria, supplier networks, and program parameters change continuously. We at brevy.com update these guides on regular review cycles, but always verify program specifics with your CMO, your DME supplier, or DCH before relying on them for clinical or financial decisions.

If you are in a medical emergency, call 911 or go to your nearest emergency department. The information in this guide is general education and is not a substitute for direct consultation with your healthcare provider, Medicaid case manager, or a licensed attorney.

Find personalized help navigating Georgia Medicaid DME at brevy.com.