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DESCRIPTIONCommode chairs and commode chair accessories are considered to be Durable Medical Equipment (DME). DME are items which are used to serve a medical purpose, can withstand repeated use, are generally not useful to a person in the absence of illness, injury, or disease, and are appropriate for use in the patient’s home. Construction costs to the Member’s residence to accompany the equipment are not considered DME.
Indications and Criteria for DME coverage are discussed in a separate policy.
Coverage for commode chairs is subject to the terms, conditions and limitations of the DME benefit within the Member’s specific benefit plan language.
If coverage for DME is available, and the Member’s benefit plan language is not specific to commode chairs, then the following apply.
POLICYI. A standard stationary commode chair is considered medically necessary when the patient is physically incapable of utilizing regular toilet facilities. This would occur in the following situations:
II. A stationary commode chair with detachable arms is considered medically necessary when the individual meets medical necessity criteria for a standard commode chair but requires either extra width or detachable arms to facilitate transfers.
III. An extra wide, heavy-duty stationary commode chair is considered medically necessary when the individual meets medical necessity criteria for a standard commode chair and weighs ≥ 300 pounds.
Coverage is limited to a stationary commode.
The following items are considered to be not primarily medical in nature, a self-help or convenience item; and therefore are considered not medically necessary:
POLICY EXCEPTIONSFor Federal Employee Program (FEP): Follow FEP guidelines.
State Health Plan (State and School Employees): Commode chairs may be covered based on medical necessity as determined by the Medical Review Department.
POLICY GUIDELINESThe coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member’s specific benefit plan language.
POLICY HISTORY10/01/2009: Policy Approved by Business Committee
10/21/2009: FEP verbiage added to Policy Exceptions Section
11/19/2009: Approved by Medical Policy Advisory Committee (MPAC)
03/30/2011: State Health Plan verbiage added to the Policy Exceptions section.
05/08/2013: Policy reviewed; no changes.
07/13/2015: Code Reference section updated for ICD-10.
SOURCESCenters for Medicare and Medicaid Services, Medicare Coverage Database, Local Coverage Determination (L4991) and Article (A23837)
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.
This is not an all-inclusive list of non-covered procedure codes.
The code(s) listed below and ANY code not listed in the previous section are considered non-covered for this procedure.