Billing Guidelines for Monthly DME Medical Supplies

In order to avoid denials, Health Choice Utah is clarifying billing guidelines for monthly medical supplies. On August 11, 2025, Health Choice Utah started applying the following logic:

Medical supplies filled on a monthly basis may be refilled between days 25 and 30 to ensure uninterrupted access for the member. This early refill window is intended to prevent supply shortages and does not authorize providers to duplicate supplies for the same dates of service.

Example Scenario

A provider is fulfilling an ongoing order for disposable urinary catheters (HCPCS code A4349), which is limited to 36 units per month under Medicaid policy. The provider has already supplied 36 units for April and needs to ship May’s supply in advance to prevent a supply shortage.

In this case:

• The provider may ship May’s supply between April 25 and April 30.
• The dates of service reported on the CMS-1500 claim form should reflect the actual usage period: May 1–May 31.
• The shipping or delivery date may be included in Box 19 ("Additional Claim Information") of the claim form, if desired.

Important:

• The provider may not supply additional catheters for April, as the utilization limit has already been met.
• Do not bill with a single date of service when filling a monthly supply. Use the From and To date span to avoid a denial.