23 Miss. Code. R. 209-1.27 - Hip Abductor Pillow/Wedge

A. Medicaid defines a hip abductor pillow wedge as a foam triangular shaped device placed between the beneficiary's thighs and secured with straps. The device maintains constant abduction.

B. Medicaid covers hip abductor pillow wedges for all beneficiaries when prior authorized by the Utilization Management and Quality Improvement Organization (UM/QIO), the Division of Medicaid or designated entity, for purchase only, when ordered by a physician and one (1) of the following apply:

1. A diagnosis which has resulted in a condition that requires maintaining the beneficiary's hips and thighs in abduction,

2. Subluxing or dislocating hip(s),

3. A diagnosis of an unstable hip,

4. Following the reduction of a dislocated hip,

5. Following hip replacement (hemi or total),

6. Following hip arthroplasty or hip fracture surgery,

7. Following adductor tenotomy or abductor advancement surgery, or

8. Wheelchair patients who must maintain a degree of hip abduction.

Notes

23 Miss. Code. R. 209-1.27

U.S.C. § 1395m; Miss. Code Ann. §§ 43-13-117(17), 43-13-121.

Amended 9/1/2018