OAR 410-122-0600
Toilet Supplies
(1)
The Division may consider coverage for commodes when:(a)
The client is physically incapable of utilizing regular toilet facilities. This would occur when the client is confined to:(A)
A single room; or(B)
One level of the home environment and there is no toilet on that level; or(C)
The home and there are no toilet facilities in the home.(b)
Extra-wide/heavy-duty commodes may be covered when a client weighs 300 pounds or more and meets the conditions of coverage for commodes;(c)
Only bariatric commodes coded as E1399 (durable medical equipment, miscellaneous) may be covered for a client residing in a nursing facility, subject to service limitations of Division rules, when all of the following requirements are met:(A)
The client meets the conditions of coverage as specified in this rule; and(B)
The bariatric commode has been assigned code E1399 by the Medicare Pricing, Data Analysis and Coding (PDAC) contractor.(2)
Documentation requirements:(a)
Documentation must include the practitioner’s order, the client’s height and weight and information supporting the medical appropriateness for the commode dispensed;(b)
For codes requiring prior authorization (PA), submit documentation which supports conditions of coverage are met as specified in this rule.(3)
Procedure Codes: Table 122-0600 Toilet Supplies.
Source:
Rule 410-122-0600 — Toilet Supplies, https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-122-0600
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