evekhm/cms_iom_500 huggingface dataset:
(Medicare National Coverage Determinations Manual)
Braille Teaching Texts  Deny --educational equipment; not primarily medical in nature ( 1861(n)  of the Act).   Canes  Covered if patient meets Mobility Assistive Equipment clinical criteria (see 280.3 of this manual).   Carafes  Deny --convenience item; not primarily medical in nature (1861(n) of the Act).   Catheters  Deny non-reusable disposable supply ( 1861(n)  of the Act).  (See Medicare Claims Processing Manual, Chapter 20, DMEPOS).   Commodes  Covered if patient is confined to bed or room.  NOTE:  The term room -confined means that patients condition is such that leaving the room is medically Item  Coverage   contraindicated.  The accessibility of bathroom facilities generally would not be a factor in this determination. However, confinement of a patient to a home in a case where there are no toilet facilities in the home may be equated to room confinement.  Moreover, payment may also be made if a patients medical condition confines him to a floor of the home and there is no bathroom located on that floor.  Communicators  (See 50.1  of this manual, Speech Generating Devices.)   Continuous Passive Motion  Devices  Continuous passive motion devices are devices covered for patients who have received a total knee replacement.  To qualify for coverage, use of the device must commence within 2 days following surgery.  In addition, coverage is limited to that portion of the 3 -week period following surgery during which the device  is used in the patients home.  There is insufficient evidence to justify coverage for longer periods of time or for other applications.  Continuous Positive Airway Pressure (CPAP) Devices  (See 240.4  of this manual.)  Crutches  Covered if patient meets Mobility Assistive Equipment clinical criteria (see section 280.3 of this 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
(Medicare National Coverage Determinations Manual)
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).
(Medicare National Coverage Determinations Manual)
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.)
(Medicare National Coverage Determinations Manual)
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.
(Medicare National Coverage Determinations Manual)
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.)
(Medicare National Coverage Determinations Manual)
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.)
(Medicare National Coverage Determinations Manual)
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    Ultraviolet Cabinets  Covered for selected patients with generalized intractable psoriasis.  Using appropriate consultation, the A/B MAC (HHH) or DME MAC should determine whether medical/other factors justify treatment at home rather than at alternative sites, e.g., outpatient department of a hospital.  Urinals autoclavable  Covered if patient is bed -confined (hospital type).   Vaporizers  Covered if patient has a respiratory illness.   Ventilators  Covered for treatment of neuromuscular diseases, thoracic restrictive diseases, and chronic respiratory failure consequent to chronic obstructive pulmonary disease.  Includes both positive/negative pressure types. (See 240.5 of this manual.)   Walkers  Covered if patient meets Mobility Assistive Equipment clinical criteria (see 280.3 of this manual).   Water and Pressure Pads and Mattresses  (See Alternating Pressure Pads, Mattresses, and Lambs Wool Pads.)  Wheelchairs (manual)
(Medicare National Coverage Determinations Manual)
Water and Pressure Pads and Mattresses  (See Alternating Pressure Pads, Mattresses, and Lambs Wool Pads.)  Wheelchairs (manual)   Covered if patient meets Mobility Assistive Equipment clinical criteria (see 280.3 of this manual).  Wheelchairs (power -operated)   Covered if patient meets Mobility Assistive Equipment clinical criteria (see 280.3 of this manual). Wheelchairs (scooter/POV)    Covered if patient meets Mobility Assistive Equipment clinical criteria (see 280.3 of this manual).   Wheelchairs (specially -sized)  Covered if patient meets Mobility Assistive Equipment clinical criteria (see 280.3 of this manual).   Whirlpool Bath Equipment  Covered if patient is homebound and has a (standard) 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 t he 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 determination.   Item  Coverage   Whirlpool Pumps  Deny --(See Portable Whirlpool Pumps.) ( 1861(n)  of the Act).   White Canes  Deny -- (See 280.2  of this manual.) (Not considered Mobility Assistive Equipment)   Cross -references: Medicare Benefit Policy Manual, Chapters 13, Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services, 15, Covered Medical and Other Health Services.   Medicare Claims Processing Manual, Chapters 12, Physician/Practitioner Billing, 20, Durable Medical Equipment, Prosthetics and Orthotics, and Supplies (DMEPOS), 23, Fee Schedule Administration and Coding Requirements.   280.2 - White Cane for Use by a Blind Person  (Rev. 1, 10- 03-03) CIM 60 -3  Not Covered   A white cane for use by a blind person is more an identifying and self -help device than an item which makes a meaningful contribution in the treatment of an illness or injury.  280.3 - Mobility Assistive Equipment (MAE) (Effective May 5, 2005)  (Rev. 37, Issued:  06- 03-05; Effective:  05 -05-05; Implementation:  07- 05-05)
(Medicare National Coverage Determinations Manual)
A.  General   The Centers for Medicare & Medicaid Services (CMS) addresses numerous items that it terms mobility assistive equipment (MAE) and includes within that category canes, crutches, walkers, manual wheelchairs, power wheelchairs, and scooters.  This list, howe ver, is not exhaustive.   Medicare beneficiaries may require mobility assistance for a variety of reasons and for varying durations because the etiology of the disability may be due to a congenital cause, injury, or disease.  Thus, some beneficiaries experiencing temporary disabili ty may need mobility assistance on a short -term basis, while in contrast, those living with chronic conditions or enduring disabilities will require mobility assistance on a permanent basis.   Medicare beneficiaries who depend upon mobility assistance are found in varied living situations.  Some may live alone and independently while others may live with a caregiver or in a custodial care facility.  The beneficiarys environment is relevant to t he determination of the appropriate form of mobility assistance that should be employed.  For many patients, a device of some sort is compensation for the mobility deficit.  Many beneficiaries experience co- morbid conditions that can impact their ability to safely utilize MAE independently or to successfully regain independent function even with mobility assistance.   The functional limitation as experienced by a beneficiary depends on the beneficiarys physical and psychological function, the availability of other support, and the beneficiarys living environment.  A few examples include muscular spasticity, cognitive deficits, the availability of a caregiver, and the physical layout, surfaces, and obstacles that exist in the beneficiarys living environment.  B.  Nationally Covered Indications   Effective May 5, 2005, CMS finds that the evidence is adequate to determine that MAE is reasonable and necessary for beneficiaries who have a personal mobility deficit sufficient to impair their participation in mobility -related activities of daily living (MRADLs) such as toileting, feeding, dressing, grooming, and bathing in customary locations within the home.  Determination of the presence of a mobility deficit will be made by an algorithmic process, Clinical Criteria for MAE Coverage, to provide the appropriate MAE to correct the mobility deficit.   Clinical Criteria for MAE Coverage
(Medicare National Coverage Determinations Manual)
Clinical Criteria for MAE Coverage   The beneficiary, the beneficiarys family or other caregiver, or a clinician, will usually initiate the discussion and consideration of MAE use.  Sequential consideration of the questions below provides clinical guidance for the coverage of equipment of appropriate type and complexity to restore the beneficiarys ability to participate in MRADLs such as toileting, feeding, dressing, grooming, and bathing in customary locations in the home.  These questions correspond to the numbered decision points on the a ccompanying flow chart.  In individual cases where the beneficiarys condition clearly and unambiguously precludes the reasonable use of a device, it is not necessary to undertake a trial of that device for that beneficiary.   1.  Does the beneficiary have a mobility limitation that significantly impairs his/her ability to participate in one or more MRADLs in the home?  A mobility limitation is one that:  a. Prevents the beneficiary from accomplishing the MRADLs entirely, or,   b. Places the beneficiary at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to participate in MRADLs, or,   c. Prevents the beneficiary from completing the MRADLs within a reasonable time frame.   2.  Are there other conditions that limit the beneficiarys ability to participate in MRADLs at home?   a. Some examples are significant impairment of cognition or judgment and/or vision.  b. For these beneficiaries, the provision of MAE might not enable them to participate in MRADLs if the comorbidity prevents effective use of the wheelchair or reasonable completion of the tasks even with MAE.  3.  If these other limitations exist, can they be ameliorated or compensated sufficiently such that the additional provision of MAE will be reasonably expected to significantly improve the beneficiarys ability to perform or obtain assistance to participat e in MRADLs in the home?
(Medicare National Coverage Determinations Manual)
a. A caregiver, for example a family member, may be compensatory, if consistently available in the beneficiary's home and willing and able to safely operate and transfer the beneficiary to and from the wheelchair and to transport the beneficiary using the wheelchair.  The caregivers need to use a wheelchair to assist the beneficiary in the MRADLs is to be considered in this determination.  b. If the amelioration or compensation requires the beneficiary's compliance with treatment, for example medications or therapy, substantive non- compliance, whether willing or involuntary, can be grounds for denial of MAE coverage if it results in the bene ficiary continuing to have a significant limitation.  It may be determined that partial compliance results in adequate amelioration or compensation for the appropriate use of MAE.   4.  Does the beneficiary or caregiver demonstrate the capability and the willingness to consistently operate the MAE safely?   a. Safety considerations include personal risk to the beneficiary as well as risk to others.  The determination of safety may need to occur several times during the process as the consideration focuses on a specific device.   b. A history of unsafe behavior in other venues may be considered.   5.  Can the functional mobility deficit be sufficiently resolved by the prescription of a cane or walker?   a. The cane or walker should be appropriately fitted to the beneficiary for this evaluation.   b. Assess the beneficiarys ability to safely use a cane or walker.   6.  Does the beneficiarys typical environment support the use of wheelchairs including scooters/power -operated vehicles (POVs)?   a. Determine whether the beneficiarys environment will support the use of these types of MAE.   b. Keep in mind such factors as physical layout, surfaces, and obstacles, which may render MAE unusable in the beneficiarys home.   7.  Does the beneficiary have sufficient upper extremity function to propel a manual wheelchair in the home to participate in MRADLs during a typical day?  The manual wheelchair should be optimally configured (seating options, wheelbase, device weight, and other appropriate accessories) for this determination.   a. Limitations of strength, endurance, range of motion, coordination, and absence or deformity in one or both upper extremities are relevant.