Reminder: Documentation Requirements for DME and Medical Supply Claims
Date: May 28, 2026
Attention: Durable Medical Equipment (DME) Providers
Texas Children’s Health Plan (TCHP) would like to remind Durable Medical Equipment (DME) providers of the importance of complying with Texas Medicaid Provider Procedures Manual (TMPPM) guidelines. Specifically, TCHP is reinforcing documentation requirements for DME and medical supply claims that do not have an established HCPCS fee schedule.
Policy Reminder
For manually priced items, providers must submit documentation of one of the following:
- Manufacturer’s Suggested Retail Price (MSRP) or Average Wholesale Price (AWP), as applicable, OR
- Provider’s documented invoice cost
Important:
- Only one form of documentation is required for consideration of payment
- Handwritten or altered invoices (e.g., crossed-out or changed values) will NOT be accepted as valid documentation.
Submission Requirements
To avoid claim denials or further action:
- Submit valid MSRP or AWP documentation OR invoice cost documentation
- Ensure all documentation is complete and unmodified
- Bill according to TMPPM guidelines for unlisted or manually priced codes
Monitoring
Claims will continue to be monitored for compliance. Providers who demonstrate ongoing non-compliance, including repeated submission of incomplete documentation or billing inaccuracies, may be referred for further review.
Next Steps
We encourage providers to review billing practices and ensure alignment with these requirements. Reach out to your assigned Account Lead or Provider Relations Liaison
(PRL) for questions or guidance. If you’re not sure who your PRL is, visit www.texaschildrenshealthplan.org/for-providers/meet-our-team.
Resources
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts: https://www.texaschildrenshealthplan.org/provideralerts.