Licensing as an Out-of-State DME Supplier

An out-of-state DME supplier is any supplier whose location is in one state and whose patients are in another. State law treats that supplier in one of five ways: it licenses the out-of-state location as if it were local, it asks for a lighter registration, it requires the supplier to have a location inside the state or near the patient, it limits which out-of-state businesses can qualify at all, or it has no general supplier license. Which one applies depends on the state and, often, on the products you ship.

Medicare does not sort this out for you. The supplier standards require compliance with "State licensure and regulatory requirements" for the items you furnish (42 CFR 424.57(c)(1)(ii)), and the CMS-855S asks each location to list every state where it provides items and to "submit all required licenses for the products and services being provided" (Section 2D). The answer has to come from each state's own law.

Which states license the out-of-state location itself?

Several states write out-of-state suppliers straight into the licensing requirement. Their applications look much like an in-state one.

• North Carolina. "Each place, whether located in this State or out-of-state, that delivers medical equipment to the user of the equipment in this State shall register annually with the Board" and obtain a medical equipment permit (N.C. Gen. Stat. 90-85.22(b)). A device permit covers prescription devices and also medical equipment. See North Carolina's permits.
• Mississippi. No business "located in this state or outside of this state" may sell, rent or provide home medical equipment, legend devices or medical gas directly to patients in Mississippi without a Medical Equipment Supplier Permit (Miss. Code 73-21-108(2)(a)). The Board of Pharmacy's summary of House Bill 856 (2025) says the reenacted section added language to make that out-of-state coverage clear.
• Tennessee. The rules define home medical equipment services as selling or renting equipment for delivery to a residence in Tennessee "regardless of the location of the home medical equipment provider," and list out-of-state providers without a physical location and mail order companies as license categories (Tenn. Comp. R. & Regs. 0720-30-.01(22)-(23)). A Tennessee location is optional. See Tennessee's HME license.
• Florida. AHCA's rule requires a license for "Any location out of state that offers to sell or rent home medical equipment requiring services to consumers in Florida" (Fla. Admin. Code 59A-25.002(1)(d)). See Florida's HME license.
• Louisiana and North Dakota. Both require a Board of Pharmacy credential and registration with the Secretary of State. Louisiana "shall not issue a DME permit to any person or other entity that has not registered with the Louisiana Secretary of State" (La. Admin. Code tit. 46, LIII-2403(C)). North Dakota bars an out-of-state retailer from doing business until it is licensed, has paid the fee and is registered with the Secretary of State (N.D. Cent. Code 43-15.3-11(2)).

Where is a registration enough?

Some states draw a line between suppliers they license and suppliers they only register.

California licenses home medical device retailers inside the state and registers those outside it. An out-of-state retailer may not sell or distribute prescription devices in California without registering (Health & Safety Code 111656.7), and CDPH says out-of-state facilities "must supply prescription medical devices in order to qualify for the registration." The registration fee is $280 a year as of the July 23, 2026 fee notice. See California's HMDR license.

Virginia requires a nonresident medical equipment supplier registration from anyone outside Virginia that ships syringes or needles, medicinal oxygen, prescription-only (Schedule VI) devices, sterile water or saline for irrigation, or peritoneal dialysis solutions to Virginia consumers on a prescriber's order. It renews by March 1 each year (Va. Code 54.1-3435.3:1). See Virginia's permit and nonresident registration.

Ohio issues a full license only to providers physically located in Ohio. "A HME services provider located outside the boundaries of the state of Ohio may only apply for a certificate of registration," and registration requires accreditation from The Joint Commission or another body the board recognizes (Ohio Admin. Code 4729:11-2-01(A)(3)(a), (B)(3)). See Ohio's HME license and registration.

Which states require a location inside the state?

Three of the states we have read do, in different ways. Alabama has required since June 1, 2014 that an HME provider based outside the state "maintain at least one physical location within the state, each of which must be licensed by the Board." Once it has one, it may serve Alabama customers through out-of-state branches, and the Alabama location answers for them (Ala. Admin. Code 473-X-3-.02). Indiana's statute requires every provider to "Maintain a physical facility and medical equipment inventory in Indiana" (IC 25-26-21-6(b)(2)). Oklahoma's Board of Pharmacy rule frames it by distance: it waives the need to "maintain a physical office or place of business within Oklahoma or within one hundred (100) miles of a resident of Oklahoma being served" only for an accredited supplier of a specialized product "not available through standard local DME channels" (Okla. Admin. Code 535:20-10-3(a)(5)).

For a national supplier, these rules mean a lease, staff and an inspection in that state, not just paperwork. CBIC acknowledged the problem in a Round 2028 FAQ about small suppliers who cannot meet "the requirement for a physical location in a specific state," and answered that a network of small suppliers can meet the licensing requirements collectively. See Alabama's in-state location rule.

Where can only some out-of-state businesses qualify?

Georgia is the clearest case. Its rule requires a license from in-state DME suppliers and from "any Medicare enrolled out-of-state DME manufacture or wholesale distributor that provides durable medical equipment to consumers in this state" (Ga. Comp. R. & Regs. 480-7B-.02(1)). The Board's application, revised November 14, 2024, asks whether the applicant is licensed anywhere as a manufacturer or wholesaler and says that if not, "you DO NOT QUALIFY under the law for an out-of-state GA DME permit." An out-of-state retail supplier should ask the Board directly how it applies to its products. See Georgia's DME supplier license.

Is there anywhere with no general license?

Texas. The Department of State Health Services licenses device distributors, defined as businesses that move devices "to the person who makes final delivery or sale to the ultimate user," and exempts "distribution from a place of business located outside the State of Texas" (25 Tex. Admin. Code 229.433(8), 229.434(a)(2)). A supplier selling to Texas patients falls outside that license. Product rules can still apply, and the exemption does not excuse anyone from the rest of the Texas Food, Drug, and Cosmetic Act (229.434(c)). See does Texas require a DME license?

What do out-of-state applications usually ask for?

Beyond the usual ownership, insurance and location details, expect these:

1. Your home-state license. Virginia requires a nonresident registrant to hold its home state's license, "if required by the resident state," or to prove it meets Virginia's standards (54.1-3435.3:1(B)). Georgia asks for "proof of a valid, unexpired license to operate as a DME supplier" in the other state.
2. Accreditation. Florida requires an out-of-state applicant to submit accreditation or an application for it, then non-provisional accreditation within 120 days, or "the application shall be withdrawn" (Fla. Stat. 400.931(2)). Ohio's registration depends on it.
3. An inspection or survey. Tennessee providers without a physical location "must comply with survey requirements and provide access and documentation to surveyors" (0720-30-.01(22)(b)). Kentucky charges the full cost of an inspection outside Kentucky (201 KAR 47:010 Section 9).
4. A notarized signature. Georgia requires attachments "signed by the owner, partner, or one of the executive officers of the corporation and notarized." Alabama requires a certification "signed by a person with the authority to bind the applicant and notarized under oath" (473-X-3-.01).

Does each of my locations need its own licenses?

Usually, yes, because Medicare enrolls each location separately ("CMS issues only one supplier number for each location," 424.57(b)(2)) and states license by location too. For competitive bidding, CBIC says the locations on a bid must together meet every state's requirements: "If a State/Territory requires a specific license, the bidder must ensure at least one of its locations meets the applicable requirements." Planning which location holds which state's license is part of the work. See getting your state licenses into PECOS.

How do we help?

We read each state's rule against your products and locations, prepare every application and attachment, and coordinate the notary and Secretary of State steps. Your owner or an officer signs, and you pay each state. We can mail the signed paper application or send an emailed one; state portals stay in your account. We cannot promise a state's decision or timing. Pricing: $699 per state, $899 for California, Florida, Georgia and Alabama, or the 10-state Remote Delivery Licensing Package at $4,995 (pricing). The state index shows what we have verified for each state.