Commodes

Commod es are covered when medically necessary because the beneficiary cannot reasonably use regular toilet facilities — examples include confinement to a single room, confinement to one home level with no toilet on that level, or no toilet in the home. Specific HCPCS-coded items have item-specific criteria: E0168 is covered only for beneficiaries weighing ≥300 lbs; E0165 is covered when detachable arms are necessary for transfers or body width; E0170/E0171 (seat lift mechanisms) require both commode medical necessity and meeting separate seat lift LCD criteria. Documentation requirements (signed SWO/WOPD prior to claim or delivery, POD, and correct HCPCS coding) must be met or claims will be denied; bidets and bidet seats are non-covered.

"Commode is covered when the beneficiary is physically incapable of utilizing regular toilet facilities."

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