Acceptable Documentation for Manually Priced Durable Medical Equipment and Expendable Supplies

Sept. 14, 2026

Durable medical equipment and expendable supplies, excluding nutritional products, that do not have an established Medicaid fee are subject to manual pricing.

Manual pricing is determined by the Texas Health and Human Services Commission based on one of the following:

• The manufacturer's suggested retail price less 18%
• The provider's documented invoice cost

For items requiring manual pricing, providers must submit supporting documentation with the appropriate procedure code for consideration of purchase or rental. Acceptable documentation includes one of the following:

• The manufacturer's suggested retail price or average wholesale price, as applicable
• The provider's documented invoice cost

Important documentation requirements

• Handwritten alterations to invoices, including crossing out information or changing values, render the invoice invalid and will not be accepted for pricing consideration.
• Manufacturer quotes are not accepted as documentation for manual pricing.

Resources
Providers are encouraged to review the Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook for additional guidance regarding documentation requirements and manual pricing methodologies.

Questions
If you have questions or need additional information, please:

• Contact your BCBSTX Medicaid Provider Network team at 855-212-1615 
• Submit via email to Texas Medicaid Network Department