What Is the Purpose of the Medicaid Title 19 Form?


Quick Answer

The purpose of the Medicaid Title XIX form is for a physician to order home health durable medical equipment or supplies, explains the Texas Health and Human Services Commission. The DME supplier/Medicaid provider or the prescribing physician can initiate this form. Once the physician signs Section B of the form. it becomes a prescription, and the form cannot be changed after this point, except for the addition of the durable medical equipment provider's signature.

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Full Answer

Using the Healthcare Common Procedure Coding system, the prescribing physician or supplier must provide the appropriate code in Section A of the form, notes the Texas Health and Human Services Commission. The quantity of the item must be included in this section. as well as the manufacturer's suggested retail price if the item needs manual pricing. If the physician or provider requests a custom item or a quantity of an item that exceeds the quantity limit, the individual completing the form must provide additional information explaining why the exception is medically necessary.

If a physician is prescribing more than four items, he must also complete the Addendum to the Home Health Services Title XIX DME/Medical Supplies Physician order form and submit it with the original form, reports the Texas Health and Human Services Commission. The physician must have last seen the patient for whom he is completing the form within the previous 12-month period.

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