E0162, Sitz bath chair
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- No explicit separate 'Documentation Requirements' section is provided in this policy.
- Implied documentation to support medical necessity (not explicitly listed but required to meet the selection criteria): diagnosis (e.g., hip dislocation, hip spica cast, total hip replacement, fractures, presence of artificial hip joint, subluxation/dislocation of hip), evidence that the member has a physical handicap/disease/injury that impairs ability to raise or lower self or perform essential activities of daily living, clinical documentation of impaired head and trunk control due to weakness or spasticity (for posture support chairs), documentation of postural instability, weakness, or physical deformity in children (for corner chairs, feeder seats, Carrie seats, floor sitters, Versa form chairs, adjustable high chairs), and justification that a standard chair/high chair is inadequate.
- For HCPCS-coded items limited to Traditional plans (for example E0170, E0171), documentation should support plan eligibility (Traditional plan vs HMO) and that selection criteria are met.
Key Coverage Criteria
- Versa form chair: Aetna's traditional plans consider Versa form chairs as DME for children with postural instability who, because of a physical deformity, need a chair with postural support that conforms to the shape of their body.
- Total hip chairs and other therapeutic chairs with elevated seats enable members to sit without having to lower their body to the normal level of a regular chair. Aetna traditional plans consider these chairs as DME for members with any of the following conditions: Hip dislocation; or Members with a hip spica cast; or Total hip replacement.
- Auto tilt chairs: Aetna's traditional plans consider auto tilt chairs as DME for members with impaired ability to raise or lower self due to physical handicap, disease, or injury.
- Posture support chairs: Aetna's traditional plans consider posture support chairs as DME when they are needed to provide support for physically handicapped persons with impaired head and trunk control due to weakness or spasticity.
- Transfer benches: Aetna's non-HMO plans consider transfer benches as DME where a physical handicap, disease, or injury inhibits the member's ability to raise or lower himself or herself.
- Corner chairs: Aetna traditional plans consider corner chairs as DME when needed to provide support for physically handicapped children who, because of a handicap, need postural support while sitting on the floor.
6 Active Policies
AETNA-CPB-0434, Therapeutic Chairs
DME101.000, DME Introduction
BCBSIL-DME101.000, Durable Medical Equipment (DME) Reference List
BCBSMT-DME101.000, Durable Medical Equipment (DME) Reference List
BCBSNM-DME101.000, Durable Medical Equipment (DME) Reference List
Related Codes
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