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COMMODES
Indications and Limitations of Coverage and/or Medical Necessity
A commode is covered when the patient is physically incapable of utilizing regular toilet facilities. This would occur in the following situations:
1. The patient is confined to a single room, or
2. The patient is confined to one level of the home environment and there is no toilet on that level, or
3. The patient is confined to the home and there are no toilet facilities in the home.
An extra wide/heavy duty commode chair (E0168) is covered for a patient who weighs 300 pounds or more. If the patient weighs less than 300 pounds but the basic coverage criteria for a commode chair are met, payment will be based on the least costly medically appropriate alternative, E0163.
A mobile commode chair (E0164, E0166) is not medically necessary.
A commode chair with detachable arms (E0165) is covered if the detachable arms feature is necessary to facilitate transferring the patient or if the patient has a body configuration that requires extra width.
A raised toilet seat is not covered.
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Documentation Requirements
An order for each item billed must be signed and dated by the treating physician, kept on file by the supplier, and made available to the DMERC upon request.
Claims for E0168 must include documentation of the patient's weight.
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