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

• Texas Medicaid Provider Procedures Manual (TMPPM), DME and Supplies

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

For access to all provider alerts: https://www.texaschildrenshealthplan.org/provideralerts.