E0167 — Pail or pan for use with commode chair, replacement only
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted.
- For DMEPOS base items requiring a Written Order Prior to Delivery (WOPD), the supplier must have received a signed WOPD before the item is delivered to the beneficiary.
- For DMEPOS base items that require a WOPD and also have separately billed associated options/accessories/supplies, the WOPD must list the base item and may list the separately billed items prior to delivery.
- Suppliers are required to maintain proof of delivery (POD) documentation in their files and make it available to the Medicare contractor upon request.
Key Coverage Criteria
- Commode is covered when the beneficiary is physically incapable of utilizing regular toilet facilities.
- Commode is covered when the beneficiary is confined to a single room and cannot access regular toilet facilities.
- Commode is covered when the beneficiary is confined to one level of the home and there is no toilet on that level.
- Commode is covered when the beneficiary is confined to the home and there are no toilet facilities in the home.
- Extra wide/heavy duty commode chair (HCPCS E0168) is covered when the beneficiary weighs 300 pounds or more.
- Commode chair with detachable arms (HCPCS E0165) is covered when detachable arms are necessary to facilitate transferring the beneficiary or when the beneficiary's body configuration requires extra width.
6 Active Policies
L33736 — Commodes
J19
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
BCBSOK-DME101.000 — Durable Medical Equipment (DME) Reference List
Related Codes
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