Equipment and supplies resources

The resources on this page include information Minnesota Health Care Programs (MHCP) providers need about equipment and supplies, including pricing and products lists, and additional details about certain covered and noncovered products.

Enteral nutrition

• Enteral Nutrition Auto Pricing List B4149-B4155 (PDF)
• Enteral Nutrition B4157-B4162 Auto Pricing (PDF) Updated Frequently
• Pasteurized Donor Human Milk Products List (PDF)

Incontinence products

• 2022 - 2024 T4535 Procedure Code and Modifiers Price List (PDF)
• 2024 - 2028 MHCP Incontinence Products List by HCPCS (PDF)
• 2024 - 2028 MHCP Incontinence Products List by Manufacturer (PDF)
• Requirements for Incontinence Products (DHS-3811) (PDF) 

Other resources

• Advance Recipient Notice of Non-covered Service/Item (DHS-3640) (PDF)
• AW Modifier Price List (PDF)
• Capped Rental Report (PDF)
• Durable Medical Equipment Rural Rates Price List (PDF) Updated Frequently
• DMECS Product Classification list on the Palmetto GBA website
• Gloves
• How to order an automatic blood pressure monitor for Minnesota Medicaid or MinnesotaCare members
• Incontinence Products Policy and List FAQs (PDF)
• KC Modifier Rural Price List (PDF)
• KE Modifier Rural Price List (PDF)
• KF Modifier Price List (PDF)
• KM Modifier Price List (PDF)
• KN Modifier Price List (PDF)
• KU Modifier Price List (PDF)
• Medical Supply Coverage Guide (PDF)
• MHCP Asthma home evaluations and Allergen-reducing products for children FAQs
• Oxygen (Medical) and Equipment vendor contract (PDF)