Commodes - Policy Article

Commode chairs (E0163, E0165, E0168, E0170, E0171) are covered under the DME benefit only if they satisfy Medicare benefit-category rules, statutory payment requirements, and the reasonable and necessary criteria in the related LCD; E0170/E0171 require meeting LCD seat-lift criteria and E0168 is for seats >=23 inches and supporting >=300 lb. Several items are explicitly non-covered (E0244 raised toilet seats, E0172 toilet-attached lifts, E0175 footrests, bidets A9270), and specified items under Final Rule 1713 require a face-to-face encounter and a Written Order Prior to Delivery (WOPD) or the claim will be denied. Claims must include the diagnosis code and appropriate modifiers (KX, GY, GA, GZ) per policy; missing or incorrect modifiers will result in rejection or denial, and suppliers should obtain ABNs when expecting denials and consult PDAC for coding guidance.

"Commode chairs (HCPCS E0163, E0165, E0168, E0170, E0171) are covered under the Durable Medical Equipment benefit when they meet Medicare benefit-category, statutory payment requirements, and reason..."