(Medicare National Coverage Determinations Manual)

Cushion Lift Power Seats  (See Seat Lifts.)   Dehumidifiers (room or central heating system type)  Deny --environmental control equipment; not primarily medical in nature ( 1861(n)  of the Act.   Diathermy Machines (standard pulses wave types)  Deny --inappropriate for home use (see 150.5  of this manual).   Digital Electronic Pacemaker Monitors   (See Self -Contained Pacemaker Monitors).  Disposable Sheets and Bags  Deny non-reusable disposable supplies ( 1861(n)  of the Act).   Elastic Stockings  Deny non-reusable supply; not rental -type items ( 1861(n)  of the Act.) (See 270.5 of this manual.)   Electric Air Cleaners  Deny --(see Air Cleaners.) ( 1861(n)  of the Act).   Electric Hospital Beds  (See Hospital Beds 280.7  of this manual.)  Item  Coverage    Electrical Stimulation for Wounds  Deny --inappropriate for home use. (See 270.1  of this manual.)   Electrostatic Machines  Deny --(see Air Cleaners and Air Conditioners.) ( 1861(n)  of the Act).   Elevators  Deny --convenience item; not primarily medical in nature (1861(n)  of the Act).   Emesis Basins  Deny --convenience item; not primarily medical in nature (1861(n)  of the Act).   Esophageal Dilators  Deny --physician instrument; inappropriate for patient use.   Exercise Equipment  Deny --not primarily medical in nature ( 1861(n)  of the Act).   Fabric Supports  Deny non-reusable supplies; not rental -type items (1861(n)  of the Act).   Face Masks (oxygen)  Covered if oxygen is covered. (See 240.2  of this manual.)   Face Masks (surgical)  Deny non-reusable disposable items ( 1861(n)  of the Act).   Flow Meters  (See Medical Oxygen Regulators.) (See 240.2  of this manual.)   Fluidic Breathing Assisters  (See Intermittent Positive Pressure Breathing Machines.)   Fomentation Devices  (See Heating Pads.)   Gel Flotation Pads and Mattresses   (See Alternating Pressure Pads and Mattresses.)  Grab Bars  Deny --self-help device; not primarily medical in nature  (1861(n)  of the Act).   Heat and Massage Foam Cushion Pads  Deny --not primarily medical in nature; personal comfort item ( 1861(n)  and 1862(a)(6) of the Act).   Heating and Cooling Plants  Deny --environmental control equipment not primarily medical in nature ( 1861(n)  of the Act).   Item  Coverage   Heating Pads  Covered if A/B MAC (HHH) or DME MAC medical staff determines patients medical condition is one for which the application of heat in the form of a heating pad is therapeutically effective.   Heat Lamps  Covered if A/B MAC (HHH) or DME MAC medical staff determines patients medical condition is one for which the application of heat in the form of a heat lamp is therapeutically effective.   Hospital Beds  (See 280.7  of this manual.)   Hot Packs  (See Heating Pads.)   Humidifiers (oxygen)  (See Oxygen Humidifiers.)   Humidifiers (room or central heating system types)  Deny --environmental control equipment; not medical in nature ( 1861(n)  of the Act).   Hydraulic Lifts  (See Patient Lifts.)   Incontinent Pads  Deny non-reusable supply; hygienic item ( 1861(n)  of the Act).   Infusion Pumps  For external and implantable pumps, see 40.2  of this manual.  If pump is used with an enteral or parenteral nutritional therapy system, see 180.2 of this manual for special coverage rules.   Injectors (hypodermic jet)  Deny --not covered self -administered drug supply; pressure - powered devices ( 1861(s)(2)(A)  of the Act) for injection of insulin.   Intermittent Positive Pressure Breathing Machines   Covered if patients ability to breathe is severely impaired.  Iron Lungs  (See Ventilators.)   Irrigating Kits  Deny non-reusable supply; hygienic equipment ( 1861(n)  of the Act).   Lambs Wool Pads  (See Alternating Pressure Pads, Mattresses, and Lambs Wool Pads.)   Item  Coverage   Leotards  Deny --(See Pressure Leotards.) ( 1861(n)  of the Act).   Lymphedema Pumps  Covered (See Pneumatic Compression Devices 280.6  of this manual.)   Massage Devices  Deny --personal comfort items; not primarily medical in nature ( 1861(n)  and 1862(a)(6) of the Act).   Mattresses  Covered only where hospital bed is medically necessary. (Separate Charge for replacement mattress should not be allowed where hospital bed with mattress is rented.) (See 280.7 of this manual.)   Medical Oxygen Regulators  Covered if patients ability to breathe is severely impaired. (See 240.2 of this manual.)   Mobile Geriatric Chairs  Covered if patient meets Mobility Assistive Equipment clinical criteria (see 280.3 of this manual).  (See Rolling Chairs).   Motorized Wheelchairs  Covered if patient meets Mobility Assistive Equipment clinical criteria (see 280.3 of this manual).   Muscle Stimulators  Covered for certain conditions. (See 160.12  of this manual)   Nebulizers  Covered if patients ability to breathe is severely impaired.   Oscillating Beds  Deny --institutional equipment; inappropriate for home use.   Over -bed Tables  Deny --convenience item; not primarily medical in nature (1861(n)  of the Act).   Oxygen  Covered if oxygen has been prescribed for use in connection with medically necessary DME. (See 240.2 of this manual.)   Oxygen Humidifiers  Covered if oxygen has been prescribed for use in connection with medically necessary DME for purposes of moisturizing oxygen. (See 240.2 of this manual.)   Oxygen Regulators (Medical)  (See Medical Oxygen Regulators.)   Oxygen Tents  (See 240.2  of this manual.)   Paraffin Bath Units (Portable)  (See Portable Paraffin Bath Units.)  Item  Coverage    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., walkers) satisfy patients need.   Patient Lifts  Covered if A/B MAC (HHH) or DME MAC medical staff determines patients condition is such that periodic movement is necessary to effect improvement or to arrest/retard deterioration in condition.  Percussors  Covered for mobilizing respiratory tract secretions in patients with chronic obstructive lung disease, chronic bronchitis, or emphysema, when patient/operator of powered percussor receives appropriate training by a physician/therapist, and no one competent  to administer manual therapy is available.   Portable Oxygen Systems  1.  Regulated Covered  (adjustable covered under conditions specified in a flow rate). Refer all claims to medical staff for this determination.  2.  Preset Deny  (flow rate deny emergency, first -aid, or not adjustable) precautionary equipment; essentially not therapeutic in nature.   Portable Paraffin Bath Units  Covered when patient has undergone a successful trial period of paraffin therapy ordered by a physician and patients 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 ( 1861(n)  of the Act).   Portable Whirlpool Pumps  Deny --not primarily medical in nature; personal comfort items ( 1861(n)  and 1862(a)(6) of the Act).   Postural Drainage Boards  Covered if patient has a chronic pulmonary condition.   Preset Portable Oxygen Units  Deny --emergency, first -aid, or precautionary equipment; essentially not therapeutic in nature.   Pressure Leotards  Deny --non-reusable supply, not rental -type item ( 1861(n)  of the Act).  Item  Coverage    Pulse Tachometers  Deny --not reasonable or necessary for monitoring pulse of homebound patient with/without a cardiac pacemaker.   Quad -Canes  Covered if patient meets Mobility Assistive Equipment clinical criteria (see 280.3 of this manual).   Raised Toilet Seats  Deny --convenience item; hygienic equipment; not primarily medical in nature ( 1861(n)  of the Act).   Reflectance Colorimeters  (See Blood Glucose Analyzers.)   Respirators  (See Ventilators.)   Rolling Chairs  Covered if patient meets Mobility Assistive Equipment clinical criteria (see 280.3 of this manual).  Coverage is limited to those roll- about chairs having casters of at least 5 inches in diameter and specifically designed to meet the needs of ill, injured, or otherwise impaired individuals.  Coverage is denied for 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/treatment of ill/injured persons.  This type is not primarily medical in nature. ( 1861(n)  of the Act.)   Safety Rollers  Covered if patient meets Mobility Assistive Equipment clinical criteria (see 280.3 of this manual).   Sauna Baths  Deny --not primarily medical in nature; personal comfort items ( 1861(n)  and ( 1862(a)(6) of the Act).   Seat Elevation Equipment (power -operated) on            Medicare Covered P ower Wheelchairs   DME on Medicare -covered power wheelchairs, and  covered under conditions specified in 280.16 of this manual  Seat Lifts  Covered under conditions specified in 280.4  of this manual. Refer all to medical staff for this determination.   Self-Contained Pacemaker Monitors  Covered when prescribed by a physician for a patient with a cardiac pacemaker. (See 20.8.1 and 280.2 of this manual.)   Item  Coverage   Sitz Baths  Covered if A/B MAC (HHH) or DME MAC medical staff determines patient has an infection/injury of the perineal area and the item has been prescribed by the patients physician as part of planned regimen of treatment in patients home.  Spare Tanks of Oxygen  Deny --convenience or precautionary supply.   Speech Teaching Machines  Deny --education equipment; not primarily medical in nature (1861(n)  of the Act).   Stairway Elevators  Deny --(See Elevators.) ( 1861(n)  of the Act).   Standing Tables  Deny --convenience item; not primarily medical in nature (1861(n)  of the Act).   Steam Packs  These packs are covered under same condition s as heating pads. (See Heating Pads.)   Suction Machines  Covered if A/B MAC (HHH) or DME MAC medical staff determines that the machine specified in the claim is medically required and appropriate for home use without technical/professional supervision.  Support Hose  Deny (See Fabric Supports.) ( 1861(n)  of the Act).   Surgical Leggings  Deny --non-reusable supply; not rental -type item ( 1861(n)  of the Act).   Telephone Alert Systems  Deny --these are emergency communications systems and do not serve a diagnostic/therapeutic purpose.   Toilet Seats  Deny --not medical equipment ( 1861(n)  of the Act).   Traction Equipment  Covered if patient has orthopedic impairment requiring traction equipment that prevents ambulation during period of use.  (Consider covering devices usable during ambulation; e.g., cervical traction collar, under brace provision.)   Trapeze Bars  Covered if patient is bed -confined and needs a trapeze bar to sit up because of respiratory condition, to change body position for other medical reasons, or to get in/out of bed.   Treadmill Exercisers  Deny --exercise equipment; not primarily medical in nature (1861(n)  of the Act).  Item  Coverage