Items include, but not limited to the following:
Lift Chairs:
Common Diagnoses: COPD (496), Osteoarthritis
(715.98), Coronary Artery Disease (414), Mechanical problems with limbs (v.49.1)
Insurance Standard:
· Patient qualifies for partial coverage if the Lift Chair is deemed medically necessary.
- There are three lines available:
1. Casual Line
2. Gentle Line
3. Luxury Line
Wheelchairs:
Common Diagnoses: Various lower body fractures, including Leg Fractures (827.0), Femur Fracture: nos-open
(821.10), and Tibia Fracture: nos-closed (823.80). Other diagnoses include Osteoarthrosis (715.0), COPD
(496) and various neurological diagnoses.
Insurance Standard:
· Wheelchairs are covered if the following criteria are met:
1. Patient has a mobility limitation that impairs their ability to participate in one or more ability related activity
of daily living.
2. Patient mobility limitation cannot be sufficiently resolved with a walker or cane.
3. Patient has sufficient upper body strength and mental capacity to self propel; OR has a caregiver capable
and willing to propel the patient.
Other Considerations:
· Heavy duty chairs are available for those patients weighing greater than 250 pounds and extra heavy duty
chairs are available for patients weighing greater than 300 pounds.
· Lightweight versions are covered only if patient cannot propel the standard weight chair.
· In most cases if a patient qualifies for a wheelchair, patient will also qualify for a wheelchair cushion. The
cushion requires a detailed written order prior to delivery.
Walk Aids – Crutches, Canes, Walkers and Rollators:
Common Diagnoses: Osteoarthrosis (715.0), Abnormal Gait (781.2), Malaise/Fatigue (780.79), COPD (496),
CHF (428.0) and various other lower body injuries.
Insurance Standard:
· Walk aids are covered if the following criteria are met:
1. Patient must have a mobility limitation that significantly impairs ability to participate in one or more mobility
-related activity of daily living in the home.
2. Patient is able to use the walk aid safely.
3. The functional mobility deficient can be sufficiently resolved by the selected walk aid.
Other Considerations:
· Typically only one walk aid will be covered in a five year period unless the patient’s condition positively or
negatively changes and requires a different walk aid.
Hoyer Lifts:
Common Diagnoses: Quadriplegia – unspecified (344.0), Parkinson’s (322.0), Lung Cancer (162.9), CHF
(428.0), Osteoarthrosis (715.0) and various neuromuscular disorders.
Insurance Standard:
· Hoyer lifts are covered by Medicare if the transfer between bed and chair, wheelchair, or commode requires
the assistance of more than one person and without the lift the patient would be bed confined.
Trapeze Bar:
Common Diagnoses: Hip Fracture (820.8), COPD (496), Quadriplegia – unspecified (344.0), Parkinson’s
(322.0), Lung Cancer (162.9), Osteoarthrosis (715.0).
Insurance Standard:
· Trapeze bars are covered when a patient needs the device to sit up because of respiratory conditions, to
change the body positions for other medical conditions, or to get in and out of bed.
Enteral – Nutrition and Feeding Pump:
Common Diagnoses: Dysphasia (787.2) and any other diagnoses that includes impaired lower bowel absorption
or inability to swallow.
Insurance Standard: Nutrition
· Nutrition is covered if a patient experiences one of the following two occurrences:
1. A permanent non-function or disease of the structures that normally permit food to reach the small
bowel.
2. Disease of the small bowel which impairs digestion and absorption of an oral diet.
· Both these occurrences require tube feeding to provide sufficient nutrients to maintain weight
and strength commensurate with the patient’s overall health status.
· If patient can swallow, they may not qualify.
Insurance Standard: Feeding Pump
· Feeding pump is supplied for patients with one of these two afflictions:
1. Permanent non-function or disease of the structures that normally permit food to reach small bowel.
2. Disease of the small bowel which impairs digestion and absorption of an oral diet.
· Patient must also pass these three requirements:
1. Adequate nutrition must not be possible by dietary adjustment and/or oral supplements.
2. Pump must be justified by patient not tolerating gravity feed such as reflux, aspiration, diarrhea,
dumping syndrome, circulatory overload, etc…
3. Patient must require tube feeding to maintain weight and strength.
Bedside Commodes:
Common Diagnoses: Renal Failure (586), CHF (428.0), paralysis and various neuromuscular disorders.
Insurance Standard:
· A commode is covered by Medicare when the patient is physically incapable of utilizing regular toilet
facilities. Patient must meet one of the following criteria:
1. Patient is confined to a single room; or
2. Patient is confined to one level of the home and there is no toilet on that level; or
3. Patient is confined to the home and there are no toilet facilities in the home.
Bath Aids – Tub Transfer Bench, Shower Chair, Grab Bars, Hand-Held Shower Heads:
· Not covered by Medicare, however, may be covered by some commercial plans.
Lift Chairs:
Common Diagnoses: COPD (496), Osteoarthritis
(715.98), Coronary Artery Disease (414), Mechanical problems with limbs (v.49.1)
Insurance Standard:
· Patient qualifies for partial coverage if the Lift Chair is deemed medically necessary.
- There are three lines available:
1. Casual Line
2. Gentle Line
3. Luxury Line
Wheelchairs:
Common Diagnoses: Various lower body fractures, including Leg Fractures (827.0), Femur Fracture: nos-open
(821.10), and Tibia Fracture: nos-closed (823.80). Other diagnoses include Osteoarthrosis (715.0), COPD
(496) and various neurological diagnoses.
Insurance Standard:
· Wheelchairs are covered if the following criteria are met:
1. Patient has a mobility limitation that impairs their ability to participate in one or more ability related activity
of daily living.
2. Patient mobility limitation cannot be sufficiently resolved with a walker or cane.
3. Patient has sufficient upper body strength and mental capacity to self propel; OR has a caregiver capable
and willing to propel the patient.
Other Considerations:
· Heavy duty chairs are available for those patients weighing greater than 250 pounds and extra heavy duty
chairs are available for patients weighing greater than 300 pounds.
· Lightweight versions are covered only if patient cannot propel the standard weight chair.
· In most cases if a patient qualifies for a wheelchair, patient will also qualify for a wheelchair cushion. The
cushion requires a detailed written order prior to delivery.
Walk Aids – Crutches, Canes, Walkers and Rollators:
Common Diagnoses: Osteoarthrosis (715.0), Abnormal Gait (781.2), Malaise/Fatigue (780.79), COPD (496),
CHF (428.0) and various other lower body injuries.
Insurance Standard:
· Walk aids are covered if the following criteria are met:
1. Patient must have a mobility limitation that significantly impairs ability to participate in one or more mobility
-related activity of daily living in the home.
2. Patient is able to use the walk aid safely.
3. The functional mobility deficient can be sufficiently resolved by the selected walk aid.
Other Considerations:
· Typically only one walk aid will be covered in a five year period unless the patient’s condition positively or
negatively changes and requires a different walk aid.
Hoyer Lifts:
Common Diagnoses: Quadriplegia – unspecified (344.0), Parkinson’s (322.0), Lung Cancer (162.9), CHF
(428.0), Osteoarthrosis (715.0) and various neuromuscular disorders.
Insurance Standard:
· Hoyer lifts are covered by Medicare if the transfer between bed and chair, wheelchair, or commode requires
the assistance of more than one person and without the lift the patient would be bed confined.
Trapeze Bar:
Common Diagnoses: Hip Fracture (820.8), COPD (496), Quadriplegia – unspecified (344.0), Parkinson’s
(322.0), Lung Cancer (162.9), Osteoarthrosis (715.0).
Insurance Standard:
· Trapeze bars are covered when a patient needs the device to sit up because of respiratory conditions, to
change the body positions for other medical conditions, or to get in and out of bed.
Enteral – Nutrition and Feeding Pump:
Common Diagnoses: Dysphasia (787.2) and any other diagnoses that includes impaired lower bowel absorption
or inability to swallow.
Insurance Standard: Nutrition
· Nutrition is covered if a patient experiences one of the following two occurrences:
1. A permanent non-function or disease of the structures that normally permit food to reach the small
bowel.
2. Disease of the small bowel which impairs digestion and absorption of an oral diet.
· Both these occurrences require tube feeding to provide sufficient nutrients to maintain weight
and strength commensurate with the patient’s overall health status.
· If patient can swallow, they may not qualify.
Insurance Standard: Feeding Pump
· Feeding pump is supplied for patients with one of these two afflictions:
1. Permanent non-function or disease of the structures that normally permit food to reach small bowel.
2. Disease of the small bowel which impairs digestion and absorption of an oral diet.
· Patient must also pass these three requirements:
1. Adequate nutrition must not be possible by dietary adjustment and/or oral supplements.
2. Pump must be justified by patient not tolerating gravity feed such as reflux, aspiration, diarrhea,
dumping syndrome, circulatory overload, etc…
3. Patient must require tube feeding to maintain weight and strength.
Bedside Commodes:
Common Diagnoses: Renal Failure (586), CHF (428.0), paralysis and various neuromuscular disorders.
Insurance Standard:
· A commode is covered by Medicare when the patient is physically incapable of utilizing regular toilet
facilities. Patient must meet one of the following criteria:
1. Patient is confined to a single room; or
2. Patient is confined to one level of the home and there is no toilet on that level; or
3. Patient is confined to the home and there are no toilet facilities in the home.
Bath Aids – Tub Transfer Bench, Shower Chair, Grab Bars, Hand-Held Shower Heads:
· Not covered by Medicare, however, may be covered by some commercial plans.