Action Bath Hydro Massage |
deny—(see Portable Whirlpool Pumps) |
Adjust-A-Bed |
deny—(see Beds-Lounge) |
Aero Massage |
deny—(See Portable Whirlpool Pumps) |
Aero-Pulse Surgical Leggings |
deny—(see Surgical Leggings) |
Air Cleaners |
deny—environmental control equipment: not primarily medical in nature |
Air-Fluidized Bed |
(see Bead Bed) |
Alternating Pressure Pads and Mattresses |
covered if contractor's physician determines patient has, or is highly susceptible
to, decubitus ulcers and patient's physician has prescribed the equipment for treatment
and has specified in the prescription that the patient's physician will be supervising
its use in connection with the patient's physician's course of treatment
|
American Bidet Toilet Seat |
deny—hygienic equipment |
American Sonoid Heat and Massage Foam Cushion Pad |
deny—not generally accepted by the medical profession as being therapeutically effective. |
Aqua-Whirl |
(see Portable Whirlpool Pumps) |
Aquamatic K-Pad |
covered under same conditions as heating pad. Limit payment to amount which would
be payable for ordinary heating pad
|
Aquamatic K-Thermai |
deny—institutional type equipment; inappropriate for home use |
Aquasage Portable Whirlpool Pumps |
deny—(see Portable Whirlpool Pumps) |
Arteroisonde |
see Automatic Blood Pressure Monitor |
Artificial Kidney |
coverage for chronic renal failure under certain conditions. Refer all claims to medical
staff for this determination.
|
Astromatic Bed |
deny—(see Beds-Lounge) |
Astropedic Bed |
deny—(see Beds-Lounge) |
Astro Comfort A. Bed |
deny—(see Beds—Lounge |
Audible/Visible Signal Pacemaker Monitor |
(see Self-Contained Pacemaker Monitor) |
Autolift |
deny—(see Bathtub Lifts) |
Automatic Blood Pressure |
covered if prescribed by a physician for use as part of home dialysis delivery system.
However, reimbursement is limited to the amount which would be payable for a sphygmomanometer
with cuff and stethoscope unless there is documentation that the patient's condition
is such that conventional methods of monitoring are not successful. Where the patient
has such a condition, payment will be limited to the amount which would be payable
for the least expensive automatic blood pressure monitor which is medically effective.
Where documentation is not in file and does not accompany the physician's prescription,
the intermediary should contact the physician to determine whether such a condition
exists.
|
Autosfig |
deny—physician instrument |
Auto-Tilt Chair |
deny—not generally accepted by the medical profession as being therapeutically effective. |
Bathtub Lifts |
deny—convenience item; not primarily medical in nature. |
Bathtub Seats |
deny—comfort or convenience item; hygienic equipment; not primarily medical in nature. |
Bead Bed |
deny—institutional equipment; inappropriate for home use. |
Beautyrest Adjustable Bed |
deny—(see Beds-Lounge) |
Bed Baths (home type) |
deny—hygienic equipment. |
Bed Lifter |
deny—not primarily medical in nature. |
Bedboards |
deny—not primarily medical in nature. |
Bed Pans (autoclavable hospital type) |
covered if patient is bed confined (see Hospital Beds for definition of “bed confined”). |
Bed Side Rails |
covered if patient is bed confined and has one of the following conditions: The patient
is disoriented; experiences vertigo; or has a neurological disorder resulting in incidence
of convulsive seizures (see Hospital Beds for definition of “bed
confined”)
|
Beds-Lounge (power or manual) |
deny—not a hospital bed; comfort or convenience item; not primarily medical in nature. |
Beds—Oscillating |
deny—institutional equipment; inappropriate for home use. |
Bell and Howell Language Master |
deny—(see Speech Teaching Machines) |
Bendix Respiratory Support System |
covered if patient's ability to breathe is severely impaired. |
Bidet Toilet Seat |
deny—(see American Bidet Toilet Seat) |
Bennett IPPB Machine |
covered if patient's ability to breathe is severely impaired. |
Bird Respirator (IPPB machine) |
covered if patient's ability to breathe is severely impaired. |
Blood Glucose Analyzer-Reflectance Colorimeter |
deny—unsuitable for home use. |
Braille Teaching Texts |
deny—education equipment; not primarily medical in nature. |
Burke Bed Elevator |
deny—(see Bed Lifter) |
Burke Electric Portable Commode Erector |
deny—(see Raised Toilet Seats) |
Burke Elevator Chair |
(see Seat Lift) |
Burke Toilet Seat Erector |
deny—(see Raised Toilet Seats) |
Canes |
covered if patient's condition impairs ambulation |
Carafes |
deny—convenience item; not primarily medical in nature |
Catheters |
deny—nonreusable disposable supply |
Centrifuge Readacrit |
covered when prescribed by a physician for use by a patient on home hemodialysis |
Century Bed Bath |
deny—(see Bed Baths) |
Cheney Safety Bath Lift |
deny—convenience item; not primarily medical in nature |
Circulator |
deny—institutional or physician equipment; inappropriate for home use |
Commodes |
covered if patient is confined to bed or room. The term “room confined” means that the patient's condition is such that leaving the room is medically contraindicated.
The accessibility of bathroom facilities generally would not be a factor in this determination.
However, confinement of the patient to the patient's home in a case where there are
no toilet facilities may be equated to room confinement. Moreover, payment may also
be made if a patient's medical condition confines the patient to a floor of the patient's
home and there is no bathroom located on that floor (see Hospital Beds for definition
of “bed confinement”).
|
Communic-Aid |
deny—convenience item |
Communicator |
deny—convenience item in home setting |
Cos-Medic Automasseur |
deny—(see Massage Devices) |
Crutches |
covered if patients' condition impairs ambulation |
Cushion Lift Power Seat |
(see Seat Lift) |
Dehumidifiers (room or central heating system type) |
deny—environmental control equipment; not primarily medical in nature |
Den-Mat |
(see Mattress). Payment should be based on amount payable for ordinary hospital bed
mattress
|
DePuy Flote Bed |
(see Alternating Pressure Pads and Mattresses) |
DePuy Flotation Mattress |
(see Alternating Pressure Pads and Mattresses) |
Dialysis Equipment |
(see Artificial Kidney) |
Diapulse Machine |
deny—(see Diathermy Machines) |
Diathermy Machines (standard and pushed wave types) |
deny—inappropriate for home use |
Digital Electronic Pacemaker Monitor |
covered when prescribed by a physician for a patient with a cardiac pacemaker |
Disposable Sheets and Bags |
deny—nonreusable disposable supplies |
Dual King Bed |
deny—(see Beds-Lounge) |
Ease-O-Matic Bed Spring |
deny—(see Beds-Lounge) |
Eaton E-Z Bath |
deny—(see Bathtub Seats) |
Elastic Stockings |
deny—nonreusable supply, not rental-type items |
Electra-Rest Bed |
deny—(see Beds-Lounge) |
Electric Air Cleaners |
deny—(see Air Cleaners) |
Electric Hospital Beds |
(see Hospital Beds) |
Electrocardiocorder |
deny—not covered as durable medical equipment—(home use may be covered only as a hospital
or physician diagnostic service)
|
Electrostatic Machines |
deny—(see Air Cleaners and Air Conditioners) |
Elevators |
deny—convenience item; not primarily medical in nature |
Emesis Basins |
deny—physician instrument |
Esophageal Dilator |
deny—physician instrument |
Exercise Equipment |
deny—not primarily medical in nature |
Exercycle |
deny—exercise equipment; not primarily medical in nature |
Face Masks (oxygen) |
covered as equipment accessory (HI 00610.230)
|
Face Masks (surgical |
deny—nonreusable disposable items |
Flowmeter |
(see Medical Oxygen Regulators) |
Fluidic Breathing Assistor |
covered where there is need for IPPB device but oxygen is not required (There are
no medical indications for simultaneous home use of the assistor and an IPPB machine)
|
Franklin Electric Hospital Bed |
(see Hospital Beds) |
Gatchboard |
deny—(see Bedboards) |
Gel Flotation Pads and Mattresses |
(see Alternating Pressure Pads and Mattresses) |
Glideabout Chair |
(see Rollabout Chairs) |
Grab Bars |
deny—self-help device, not primarily medical in nature |
Grant Alternating Pressure Pads |
(see Alternating Pressure Pads and Mattresses) |
Hand-D-Jet |
deny—(see Portable Whirlpool Pumps) |
Hand-E-Vent |
(see IPPB Machines) |
Heating and Cooling Plants |
deny—environmental control equipment, not primarily medical in nature |
Heating Pads |
covered if the contractor's medical staff determines patient's medical condition is
one for which the application of heat in the form of a heating pad is therapeutically
effective.
|
Heat Lamps |
covered if the contractor's medical staff determines patient's medical condition is
one for which the application of heat in the form of a heat lamp is therapeutically
effective
|
Hemodialysis Equipment |
(see Artificial Kidney) |
Honeywell Air Purifier |
deny—(see Air Cleaners and Air Conditioner) |
Hospital Beds |
1. General |
covered if patient is bed confined and the contractor's medical staff determines patient's
condition necessitates positioning the body (especially the head, chest, legs, and
feet) in a way which would not be feasible in an ordinary bed or attachments are required
which could not be used on an ordinary bed.1 |
|
NOTE: The term “bed confined”
indicates that the patient's medical condition is of such severity that
the
patient is confined to bed, although not necessarily 100 percent of the
time.
|
2. Electrically Elevates and lowers head and foot |
covered if the contractor's physician determines patient's condition is such that
frequent change in body position is necessary and/or there may be an immediate need
for a change in position (i.e., no delay in change can be tolerated) and the patient
can effect these adjustments (by operating the controls). In all cases, verify the
medical necessity for this type of hospital bed with medical staff.
|
3. Franklin Electric Hospital Bed |
full payment for this bed should not be made. Base payment on whichever hospital bed
above satisfies the patient's medical needs. In all cases, verify medical necessity
for such features with medical staff.
|
Hoyer Lift |
(see Patient Lifts) |
Humidifiers (oxygen) |
(see Oxygen Humidifiers) |
Humidifiers (room or central heating system types) |
deny—environmental control equipment; not medical in nature |
Hydraulic Lift |
(see Patient Lifts) |
Hydrocollator Heating Unit |
deny—not essential to administration of moist heat therapy, serves no clearly identifiable
medical purpose
|
Hydrocollator Steam Packs |
effective June 15, 1978, these packs are covered under same condition as a heating
pad. Carriers limit payment to amount which would be payable for ordinary heating
pad.
|
Hydro Jet Whirlpool Bath |
deny—see Portable Whirlpool Pumps) |
Incontinent Pads |
deny—nonreusable supply; hygienic item |
Infusion Pumps |
covered if contractor's medical staff verifies the appropriateness of the therapy
and of the prescribed pump for home use. (Physician's prescription must specify that
the physician will be supervising its use in connection with a course of treatment.)
|
Inhalators |
covered if patient's ability to breathe is severely impaired |
IPPB Machines |
covered if patient's ability to breathe is severly impaired |
Iron Lungs |
covered if patient has respiratory paralysis |
Irrigating Kit |
deny—nonreusable supply; hygienic equipment |
ITI Mechanical Percussor |
(See Percussors) |
Jacuzzi Portable Whirlpool Pump |
deny—(see Portable Whirlpool Pumps) |
Jobst Pneumatic Appliances |
covered if the pneumatic appliance(s) has been prescribed for use with a medically
necessary Jobst Pneumatic Compressor
|
Jobst Pneumatic Compressor (lymphedema pump) |
(see Lymphedman Pumps—nonsegmental therapy type) |
Jobst Pressure Gradient Fabric Supports |
deny—nonreusable supplies, not rental-type item |
Jobst Stockings and Support Hose |
deny—(see Jobst Pressure Gradient Fabric Supports) |
Lakematic Power Chair |
(see Wheelchairs) |
Lambs Wool Pads |
deny—nonreusable supplies, not rental-type item |
Lattoflex Spring-Base |
deny—not a hospital bed; comfort or convenience item; not primarily medical in nature |
LC-3 Oxygen System |
deny—institutional oxygen system; not a rental-type item |
Leotards |
deny—(see Pressure Leotards) |
Lif-O-Gen Tanks |
(see Portable Oxygen Systems) |
Limb-O-Cycle |
deny—(exercise equipment; not primarily medical in nature |
Linde Oxygen Walker system |
(see Portable Oxygen Systems) |
Lumex Chair Table |
(see Rollabout Chairs) |
Lymphedema Pumps (nonsegmental therapy type) |
covered if patient had intractable edema of the extremities |
Lymphedema Pumps (segmental therapy type) |
deny—institutional or physician equipment; inappropriate for home use |
Madasphere Portable Oxygen Unit |
(see Portable Oxygen Systems) |
Magic-Dailey Bedpan |
covered when hospital-type bed pan is required. Limit payment of amount which would
be payable for ordinary hospital-type bed pan
|
Marx Oxygen Concentrator (Model 600) |
covered if patient's ability to breathe is severely impaired. |
Masks (oxygen) |
covered |
Masks |
(see Face Masks) |
Massage Devices |
deny—considered comfort items not generally accepted by the medical profession as
either medically indicated or effective.
|
Mattress |
covered only where hospital bed is medically necessary. (Separate charge for replacement
mattress should not be allowed where hospital bed with mattress is rented.)
|
Maxi-Myst |
covered if patient's ability to breathe is severely impaired |
McKune Whirlpool Bath |
deny—(see Portable Whirlpool Pumps) |
Mecalift |
(see Patient Lifts) |
Medcolator |
deny—inappropriate for home use |
Medco-Minalator |
deny—inappropriate for home use |
Medco-Sonolator Twin |
deny—inappropriate for home use |
Medco-Therm Muscle Stimulator
|
deny—inappropriate for home use |
Medic-Ease Mattress |
covered under same condition as alternating pressure pad or mattress. Base reimbursement
on less expensive item if that satisfies patient's need
|
Medical Oxygen Regulators |
covered if patient's ability to breathe is severely impaired |
Micronaire Environmental Control
|
deny—(see Air Cleaners and Air Conditioners) |
Mobile Geriatric Chair |
(see Rollabout Chairs) |
Mobile Monomatic Sanitation System |
deny—institutional type of hygienic equipment; not necessary and reasonable for home
use
|
Moore Wheel |
deny—convenience item; exercise equipment; not primarily medical in nature |
Motorized Wheelchairs |
(see Wheelchairs) |
Muscle Stimulator Burdick MS-300 |
deny—inappropriate for home use |
Myoflex Muscle Stimulator |
deny—produced no demonstrable therapeutic effect |
Nebulizers |
covered if patient's ability to breathe is severely impaired |
Niagara Massage Pillow |
deny—comfort or convenience item; not primarily medical in nature |
Niagara Thermo-Cyclopad |
deny—not generally accepted by medical profession as being therapeutically effective |
Nolan Bath Chair |
deny—comfort or convenience item; hygienic equipment, not primarily medical in nature |
Oaks Controller Unit |
deny—self-help device; institutional-type equipment |
Osci-Lite |
covered under same conditions as Heat Lamps. Limit payment to amount which would be
payable for ordinary heat lamp
|
Oscillating Beds |
deny—institutional equipment—inappropriate for home use |
Overbed Tables |
deny—convenience item; not primarily medical in nature |
Oxycane |
(see Portable Oxygen Systems) |
Oxygen |
covered if the oxygen has been prescribed for use in connection with medically necessary
durable medical equipment
|
Oxygen Humidifiers |
covered if a medical humidifier has been prescribed for use in connection with medically
necessary durable medical equipment for purposes of moisturizing oxygen
|
Oxygen Regulators (Medical) |
(see Medical Oxygen Regulators) |
Oxygen Tank |
Noncovered except as an incidental cost of providing oxygen. It is not medical equipment,
serves neither a therapeutic nor diagnostic function.
|
Oxygen Tents |
covered if patient's ability to breathe is severely impaired. |
Pace Trac |
(see Digital Electronic Pacemaker Monitor) |
Paraffin Bath Units (portable) |
(see Portable Paraffin Bath Units) |
Paraffin Bath Units (standard) |
deny—institutional equipment; inappropriate for home use |
Parallel Bars |
deny—support exercise equipment; primarily for institutional use; in the home setting
other devices e.g., a walker, satisfies the patient's need
|
Patient Lifts |
covered if contractor's physician determines patient's condition in such that periodic
movement is necessary to effect improvement or to arrest or retard deterioration in
the patient's condition
|
Percussion pac |
(see Percussors) |
Percussors |
covered for mobilizing respiratory tract secretions in patients with chronic obstructive
lung disease, chronic bronchitis, or emphysema, when patient or operator of powered
percussor has received appropriate training by a physician or therapist, and no one
competent to administer manual therapy is available.
|
Portable Oxygen Systems |
1. Regulated (adjustable flow rate) |
covered under certain circumstances. Contractor refers all claims to its medical staff
for a determination
|
2. Preset (flow rate not adjustable) |
deny |
Portable Paraffin Bath Units |
covered when the patient has undergone a successful trial period of paraffin therapy
ordered by a physician and the patient's condition is expected to be relieved by long
term use of this modality.
|
Portable Room Heaters |
deny—environmental control equipment; not primarily medical in nature |
Portable Whirpool Pumps |
deny—does not primarily and customarily serve a therapeutic purpose, generally used
for soothing or comfort purposes
|
Port-O-Matic (oxygen unit) |
(see Portable Oxygen Systems) |
Postural Drainage Boards |
covered if patient has a chronic pulmonary condition |
Posture Support Chairs |
(see Seat Lift) |
Posturpedic Mattress |
(see Mattress) |
Preset Portable Oxygen Units |
deny—emergency, first-aid, or precautionary equipment; essentially not therapeutic
in nature.
|
Pressure-Eze-Pad |
(see Alternating Pressure Pads and Mattresses) |
Pressure Leotards |
deny—nonreusable supply; not rental-type item |
Pulse Tachometer |
deny—nonreasonable or necessary for monitoring pulse of homebound patient with or
without a cardiac pacemaker
|
Quad-Canes |
(see Walkers) |
Raised Toilet Seats |
deny—convenience item; hygienic equipment; not primarily medical in nature |
Recliner with Elevating Seat |
(see Seat Lifts. Payment for this item should be limited to the amount payable for
a seat lift without the reclining chair features)
|
Renal Dialysis Equipment |
(see Artificial Kidney) |
Respirators |
covered if the contractor's medical staff determines that the apparatus specified
in the claim is medically required and appropriate for home use without technical
or professional supervision
|
Restorator |
deny—exercise equipment; not primarily medical in nature |
Rollabout Chairs |
covered if contractor's medical staff determines that the patient's condition is such
that there is a medical need for this item and it has been prescribed by the patient's
physician in lieu of a wheelchair. Coverage is limited to those rollabout chairs having
casters of at least 5 inches in diameter and specially designed to meet the needs
of ill, injured, or otherwise impaired individuals; coverage is not intended to extend
to the wide range of chairs with smaller casters as are found in general use in homes,
offices and institutions for many purposes not related to the care or treatment of
ill or injured persons.
|
Safety Grab Bars |
deny—(see Grab Bars) |
Sauna Baths |
deny—not medical in nature; primarily used to improve appearance or for comfort purposes. |
Schmidt Bed Bath |
deny—(see Bed Baths) |
Seat Lift or Tilt |
covered under certain conditions. Refer all claims to medical staff for this determination |
Select-A-Rest |
deny—see Beds-Lounge) |
Selectronair |
deny—(see Air Cleaners and Air Conditioners) |
Sigmamotor Mobile Infusion Pump |
(see Infusion Pumps) this pump is suitable for home use |
Sitz Bath |
covered if the contractor's medical staff determines patient has an infection or injury
of the perineal area and the item has been prescribed by the patient's physician as
a part of the patient's physician's planned regimen of treatment in the patient's
home
|
S.O.S. Emergency Oxygen Inhalator |
(see Portable Oxygen Systems) |
Spare Deionization Supply Tanks |
deny—conveinence or precautionary |
Spare Tanks of Oxygen |
deny—convenience or precautionary supply |
Spectroware Machine |
deny—(see Diathermy Machines) |
Speech Teaching Machines |
deny—educational equipment; not primarily medical in nature |
Sphygmomanometer with cuff |
covered if prescribed by physician for use as part of a home dialysis delivery system |
Sphygmostat |
same as above |
Stairglide |
deny—(see Elevators) |
Stairway Elevators |
deny—(see Elevators) |
Standing Table |
deny—convenience item; not primarily medical in nature |
Stethoscope |
covered if prescribed by physician for use with a sphygmomanometer as part of a home
dialysis delivery system
|
Stryker Floation Pads and Mattresses |
(see Alternating Pressure Pads and Mattresses) |
Suction Machine |
covered if the contractor's medical staff determines that the machine specified in
the claim is medically required and appropriate for home use without technical or
professional supervision
|
Superpulse Machine |
deny—(see Diathermy Machines) |
Surgi-Bed |
deny—institutional equipment, inappropriate for home use |
Surgical Leggings |
deny—nonreusable supply; not rental-type item |
Telemedic II |
deny—not covered as durable medical equipment (home use may be covered only as an
out-patient hospital or physician diagnostic service)
|
Telephone Alert Systems |
deny—these are emergency communications systems and do not serve a diagnostic or therapeutic
purpose.
|
Telephone Arms |
deny—convenience item; not medical in nature |
Therabath |
deny—(see Portable Paraffin Bath Units) |
Theramatic Machines |
deny—(see Diathermy Machines) |
Thermo-Jet |
deny—(see Portable Whirlpool Pumps) |
Toilet Seats |
deny—not medical equipment |
Traction Equipment |
covered if patient has orthopedic impairment requiring traction equipment which prevents
ambulation during the period of use. (Devices usable during ambulation, e.g., cervical
traction collar, may be covered under the brace provision)
|
Translift Chair |
deny—institutional equipment |
Trapeze Bars |
covered if patient is bed confined and there is need to sit up because of a respiratory
condition or a need to change body position for other medical reasons, or to get in
and out of bed (See Hospital Beds for definition of “bed confined”)
|
Treadmill Exerciser |
deny—exercise equipment not primarily medical in nature |
Tub Chair |
deny—(see Bathtub Seats) |
Tubo-Jet |
(see Portable Whirlpool Pumps) |
Ultraviolet Cabinet |
covered for selected patients with generalized intractable psoriasis—Using appropriate
consultation, the contractor should determine whether medical and other factors justify
treatment at home rather than at alternative sites, e.g., out-patient department of
a hospital
|
Urinals (autoclavable hospital type) |
covered if patient is bed confined—(see Hospital Beds for definition of “bed Confined”) |
Vaporizers |
covered if patient has a respiratory illness |
Vasculaider Bed |
deny—(see Oscillating Beds) |
Vasoscillating Bed |
deny—(see Oscillating Beds) |
Walkers |
covered if patient's condition impairs ambulation |
Water and Pressure Pads and Mattresses |
(see Alternating Pressure Pads and Mattresses) |
Watkins Chronofusor (infusion pump) |
(see Infusion Pumps) this pump is suitable for home use |
Wheel-O-Vator |
deny—(see Elevators) |
Wheelchairs |
covered if patient's condition is such that without the use of a wheelchair the patient
would be bed or chair confined. An individual may qualify for a wheelchair and still
be bed confined (see Hospital Beds for a definition of “bed
confined”)
|
Power operated wheelchairs and wheelchairs with other special features |
covered if patient's condition is such that a wheelchair is medically necessary and
the patient is unable to operate the wheelchair manually. Any claim involving a power
wheelchair or a wheelchair with other special features should be referred for medical
consultation since payment for the special features is limited to those which are
medically required because of the patients condition
|
|
NOTE: A power-operated vehicle that may appropriately be used as a wheelchair can be covered.
|
Whirl-a-Bath |
deny—(see Portable Whirlpool Pumps) |
Whirl-O-Matic |
deny—(see Portable Whirlpool Pumps) |
Whilepool Bath Equipment (standard) |
covered if patient is homebound and has a condition for which the whirlpool bath can
be expected to provide substantial therapeutic benefit justifying its cost. Where
patient is not homebound but has such a condition, payment is restricted to the cost
of providing the services elsewhere, e.g., an outpatient department of a participating
hospital, if that alternative is less costly. In all cases, refer claim to medical
staff for a determination.
|
Whirlpool Pumps |
deny—(see Portable Whirlpool Pumps) |