CurrentAloha CarePolicy MP-34

Durable Medical Equipment, Prosthetics & Orthotics

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Defines AlohaCare's coverage, limitations, and medical necessity criteria for durable medical equipment (DME), prosthetics, and orthotics for members in applicable lines of business (Medicaid/MA, Quest Integration). Applies to items used in the home and ordered by a treating physician.

Policy Summary

PayerAloha Care

PolicyDurable Medical Equipment, Prosthetics & Orthotics

Policy CodePolicy MP-34

Change TypeNo material changes

Effective DateOct 20, 2025

Next Review DateN/A

Key ActionOrder DME, prosthetics, or orthotics through the treating physician and document medical necessity per AlohaCare definitions and referenced state/CMS criteria.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5primary coverage criteria (all must be met)

24+listed items requiring prior authorization (not all inclusive)

limitedreimbursement excludes remote monitoring, software, data interpretation

5 yearsdefault replacement documentation threshold

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