(1)Indications and limitations of coverage and medical appropriateness
(a)The Division may cover bath supplies when medically appropriate and cost-effective including a rehab shower/commode chair when all of the following criteria are met:
(A)Client is unable to use a standard shower chair/bench due to a musculoskeletal condition;
(B)Client has positioning, trunk stability or neck support needs that a standard shower chair/bench cannot provide;
(C)The home (shower) can accommodate a rehab/shower chair;
(D)Less costly alternatives have been considered or tried and ruled out;
(E)The rehab shower/commode chair meets the following specifications and standard features as a minimum:
(i)Constructed specifically for use as a rehab shower/commode chair (corrosive resistant);
(ii)Swing-away or detachable arms;
(iii)Removable commode pan holder and pan;
(iv)Adjustable removable footrests;
(v)Wheel lock system;
(F)The rehab shower/commode chair must be supplied by a durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) provider that employs a Rehabilitation Engineering and Assistive Technology Society of North America (RESNA)-certified Assistive Technology Professional (ATP) who specializes in wheelchairs and who has direct, in-person involvement in the rehab shower/commode chair selection for the client;
(b)Verification of the healthcare common procedure coding system (HCPCS) code assignment by the Medicare Pricing, Data Analysis and Coding (PDAC) contractor is not required for a rehab shower/commode chair;
(c)Use E1399 for a rehab shower/commode chair.
(a)The practitioner’s order and medical justification for the equipment must be kept on file by the DMEPOS provider. The client’s medical records must contain information which supports the medical appropriateness of the item ordered;
(b)For a rehab shower/commode chair, submit documentation which supports conditions of coverage in this rule are met.
(3)Table 122-0580 Bath Supplies.
Rule 410-122-0580 — Bath Supplies,