E0249 — Pad for water circulating heat unit, for replacement only
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Suppliers must maintain proof of delivery (POD) documentation in their files and make POD available to the Medicare contractor upon request.
- A Standard Written Order (SWO) must be communicated to the supplier before claim submission; for DMEPOS base items requiring a Written Order Prior to Delivery (WOPD) the supplier must have a signed SWO/WOPD before delivery.
- When a DMEPOS base item requires a WOPD and associated options/accessories/supplies are separately billed, the WOPD must list the base item and may list the separately billed associated items prior to delivery.
- Suppliers and providers must follow the LCD-related Standard Documentation Requirements Article, the LCD-related Policy Article, the Supplier Manual, and DME MAC web publications for additional documentation and payment rules prior to reimbursement.
Key Coverage Criteria
- An item is covered only if it is in a defined Medicare benefit category, is reasonable and necessary for diagnosis/treatment or to improve function of a malformed body member, and meets applicable Medicare statutory and regulatory requirements.
- A standard electric heating pad (HCPCS E0210) is covered when used to relieve pain, decrease joint or soft tissue stiffness, relax muscles, or reduce inflammation.
- Raised toilet seats are considered medically necessary (Traditional plans) if member is unable to rise from toilet seat without assistance.
- Toilet seat lift (erector) is considered medically necessary if member is unable to rise from toilet seat without assistance.
- Sitz bath is considered medically necessary for infection or injury of the perineal area.
- ICD-10 diagnoses listed as 'covered if selection criteria are met' (examples include but are not limited to: A52.17 General paresis [covered for tilt/recline rehab shower commode chair]; G12.21 Amyotrophic lateral sclerosis; G35 Multiple sclerosis; G80.0-G80.9 Cerebral Palsy; G82.20-G82.22 Paraplegia; G82.50-G82.54 Quadriplegia; G83.0-G83.34 Other paralytic syndromes; L89.0-L89.96 Pressure ulcer [covered for tilt/recline rehab shower commode chair]; M24.50-M24.59 Contracture of joint [covered fo [...]
9 Active Policies
L33784 — Heating Pads and Heat Lamps
J19
AETNA-CPB-0429 — Bathroom and Toilet Equipment and Supplies
AETNA-CPB-0540 — Heating Devices
BCBSIL-DME101.000 — Durable Medical Equipment (DME) Reference List
BCBSMT-DME101.000 — Durable Medical Equipment (DME) Reference List
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