Medicare Commode LCD Coverage


A commode is covered when the beneficiary is physically incapable of utilizing regular toilet facilities. This would occur in the following situations:

  1. The beneficiary is confined to a single room, or
  2. The beneficiary is confined to one level of the home environment and there is no toilet on that level, or
  3. The beneficiary is confined to the home and there are no toilet facilities in the home.
    An extra wide/heavy duty commode chair (E0168) is covered for a beneficiary who weighs 300 pounds or more. If an E0168 commode is ordered and the beneficiary does not weigh more than 300 pounds, it will be denied as not reasonable and necessary.
    A commode chair with detachable arms (E0165) is covered if the detachable arms feature is necessary to facilitate transferring the beneficiary or if the beneficiary has a body configuration that requires extra width. If coverage criteria are not met payment will be denied as not reasonable and necessary.

Commode chair with seat lift mechanism (E0170, E0171) is covered if the beneficiary has medical necessity for a commode and meets the coverage criteria for a seat lift mechanism (see Local Coverage Determination [LCD] and Policy Article on Seat Lift Mechanisms). However, a commode with seat lift mechanism is intended to allow the beneficiary to walk after standing. If the beneficiary can ambulate, he/she would rarely meet the coverage criterion for a commode. Therefore, if the beneficiary is capable of walking from the bed to the bathroom, a KX modifier must not be added to the code for the commode with seat lift mechanism.

Group 1 Codes

Code

Description

E0163

COMMODE CHAIR, MOBILE OR STATIONARY, WITH FIXED ARMS

E0165

COMMODE CHAIR, MOBILE OR STATIONARY, WITH DETACHABLE ARMS

E0167

PAIL OR PAN FOR USE WITH COMMODE CHAIR, REPLACEMENT ONLY

E0168

COMMODE CHAIR, EXTRA WIDE AND/OR HEAVY DUTY, STATIONARY OR MOBILE, WITH OR WITHOUT ARMS, ANY TYPE, EACH

E0170

COMMODE CHAIR WITH INTEGRATED SEAT LIFT MECHANISM, ELECTRIC, ANY TYPE

E0171

COMMODE CHAIR WITH INTEGRATED SEAT LIFT MECHANISM, NON-ELECTRIC, ANY TYPE

E0172

SEAT LIFT MECHANISM PLACED OVER OR ON TOP OF TOILET, ANY TYPE

E0175

FOOT REST, FOR USE WITH COMMODE CHAIR, EACH

E0244

RAISED TOILET SEAT

The CMS.gov website is an excellent resource for finding out about all of your options.