COMMODES

Coverage Guidelines

A commode is covered when the beneficiary is physically incapable of utilizing regular toilet facilities. This would occur in the following situations:

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1. The beneficiary is confined to a single room, or

2. The beneficiary is confined to one level of the home environment and there is no toilet on that level, or

3. The beneficiary is confined to the home and there are no toilet facilities in the home.

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An extra wide/heavy duty commode chair is covered for a beneficiary who weighs 300 pounds or more. If an E0168 commode is ordered and the beneficiary does not weigh more than 300 pounds, it will be denied as not reasonable and necessary.

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A commode chair with detachable arms (drop arm commode) is covered if the detachable arms feature is necessary to facilitate transferring the beneficiary or if the beneficiary has a body configuration that requires extra width. If coverage criteria are not met payment will be denied as not reasonable and necessary.

Commode chair with seat lift mechanism is covered if the beneficiary has medical necessity for a commode and meets the coverage criteria for a seat lift mechanism. However, a commode with seat lift mechanism is intended to allow the beneficiary to walk after standing. If the beneficiary can ambulate, he/she would rarely meet the coverage criterion for a commode. Therefore, if the beneficiary is capable of walking from the bed to the bathroom.

Bidets and bidet toilet seats are non-covered.