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Bath and Toilet Equipment

Revised: 07-28-2011

  • Overview
  • Eligible Providers
  • TPL and Medicare
  • Eligible Recipients
  • Covered Services
  • Commodes
  • Commode Chair with Integrated Seat Lift Mechanism/Toilet Seat Lift Mechanism
  • Bath/Shower Chairs or Tub Stools/Benches
  • Raised Toilet Seats
  • Transfer Benches
  • Rehab Shower Commode Chairs
  • Bath Lift Equipment
  • Noncovered Services
  • Authorization
  • Billing
  • Legal References
  • Overview

    Bath and toilet equipment is used to provide support and safety to individuals during hygiene tasks.

    Eligible Providers

    The following MHCP-enrolled providers may provide bath and toilet equipment:

  • • Federally Qualified Health Centers
  • • Home health agencies
  • • Hospitals
  • • Indian Health Services
  • • Medical suppliers
  • • Pharmacies
  • • Rural Health Clinics
  • TPL and Medicare

    Providers must meet any provider criteria, including accreditation, for third party insurance or for Medicare in order to assist recipients for whom MHCP is not the primary payer.

    MHCP quantity limits and thresholds apply to all recipients unless only Medicare co-insurance or deductible is requested.

    Eligible Recipients

    Bath and toilet equipment is covered for eligible MHCP recipients who meet medical necessity criteria. Bath and toilet equipment is included in the nursing facility per diem, and is not separately reimbursable. Most bath and toilet equipment is included in the ICF/DD per diem. Seat lift mechanisms and rehab shower commode chairs may be covered outside the ICF/DD per diem for recipients who meet medical necessity criteria.

    Covered Services

    Codes:

  • • E0163-E0168 (Commodes)
  • • E0170-E0172 (Seat lift for commode/toilet)
  • • E0240 (Bath/shower chair)
  • • E0244 (Raised toilet seat)
  • • E0245 (Tub stool/bench)
  • • E0247-E0248 (Transfer benches)
  • • E0625 (Bath lift)
  • Commodes

    Commodes are covered for recipients who are unable to safely and promptly access the toilet in the bathroom in their homes due to a medical condition.

  • • MHCP does not require that recipients are confined to their beds or to their rooms
  • • A heavy-duty commode may be dispensed if a recipient’s weight, body size or stability makes a standard commode unsafe
  • • A pediatric commode is covered if the recipient is unable to safely and promptly access the bathroom in his/her home due to a medical condition, and his/her size requires a pediatric commode
  • • Because very few commodes are made for children, DHS will allow manual pricing of pediatric commodes only. Authorization is required if the expected payment exceeds the fee schedule rate
  • Commode Chair with Integrated Seat Lift Mechanism/Toilet Seat Lift Mechanism

    Commode chairs with non-electric seat lift mechanism are covered without authorization for recipients who meet criteria for a commode, but are unable to safely raise or lower themselves to use the commode.

    Commode chairs with electric seat lift mechanisms or seat lift mechanisms to be placed over the toilet are covered with authorization. Documentation must establish all of the following:

  • • The recipient is unable to safely and promptly access the toilet in the bathroom in the home because of a medical condition
  • • The medical condition is reasonably expected to last more than 10 months if purchase rather than rental is requested
  • • The recipient is unable to safely raise or lower himself to use the toilet / commode
  • • A trial has shown that the seat lift mechanism will allow the recipient to independently use the toilet/commode, and that the item fits in the recipient’s home
  • • Other less costly ways to meet the recipient’s needs (raised toilet seat, non-electric seat lift mechanism) have been considered
  • • The recipient has acknowledged that the increased independence offered by the seat lift mechanism may affect future requests for PCA or home care services
  • • Requests for authorization must address the recipient’s ability to transfer onto/off of other furniture, caregiver availability to assist with transfers and transfer method used for toileting in the community
  • Bath/Shower Chairs or Tub Stools/Benches

    Bath/shower chairs or tub stools/benches are covered without authorization for recipients who are unable to safely use the bathtub or shower in their homes.

    Raised Toilet Seats

    Raised toilet seats are covered without authorization for recipients who are unable to safely raise or lower themselves to use a standard height toilet.

    Transfer Benches

    Transfer benches are covered for recipients who are unable to safely transfer to the toilet or bath/shower chair without the use of the transfer bench. Authorization is required if the submitted charge is over $400. Documentation must establish that the requested item is the least costly appropriate way to meet the recipient’s medical needs. A transfer bench is considered a duplication of equipment if the recipient has a patient lift that can be used in the bathroom unless the transfer bench allows the recipient to transfer without assistance.

    Rehab Shower Commode Chairs

    Rehab shower commode chairs are covered for recipients who are unable to safely and promptly access the toilet and/or shower in the bathroom of their homes due to a medical condition, and who require significantly more positioning assistance than is available from a commode and/or shower chair. Providers should use the bath/shower chair HCPCS code that most appropriately describes the item, not a miscellaneous code. Authorization requests must include U3 when requesting payment above the fee schedule rate. Documentation must establish all of the following:

  • • The recipient is unable to safely and promptly access the toilet and/or shower in the bathroom in the home because of a medical condition
  • • The medical condition is reasonably expected to last more than 10 months if purchase rather than rental is requested
  • • The specific medical condition(s) that makes a commode and/or shower chair unsafe, and how the requested item will address the recipient’s medical condition(s)
  • • The amount of time the recipient will use the rehab shower commode chair daily
  • • The recipient’s living arrangement and caregiver status
  • • The requested equipment is appropriate to the recipient’s height and weight
  • • A trial has shown that the requested equipment will fit in all necessary areas of the recipient’s home
  • • Details about the recipient’s current equipment or how the recipient is currently bathing, and specific and detailed information about why it is no longer meeting the recipient’s needs or cannot be repaired
  • • Other related equipment in use (mobility device, patient lift, etc.)
  • • Other less costly ways to meet the recipient’s needs have been considered and why they will not meet the recipient’s needs. Include details including make and model of multiple less costly items considered and rejected
  • • Evaluation by physical therapist/occupational therapist/other professional with experience evaluating bath and toilet equipment
  • • When tilt in space shower commode chairs or custom molded seating is requested, additional documentation is required to support these options. The amount of time the recipient uses the equipment daily will be considered when evaluating the need for these options
  • Bath Lift Equipment

    Bath chairs that lower the recipient into the bathtub are covered for recipients who are unable to safely access the bathtub in their home due to a medical condition. Providers should use the bath lift HCPCS code that most appropriately describes the item, not a miscellaneous code. Prior authorization is always required. Authorization requests must include modifier U3 when requesting an amount above the fee schedule rate. Documentation must establish all of the following:

  • • The recipient is unable to safely access the bathtub in the home due to a medical condition
  • • The medical condition is reasonably expected to last more than 10 months if purchase rather than rental is requested
  • • The specific medical condition(s) that requires the recipient to be lowered into the bathtub to soak in the water rather than using a bath/shower chair for a shower
  • • The recipient’s living arrangement and caregiver status
  • • The requested equipment is appropriate to the recipient’s height and weight
  • • A trial has shown that the requested equipment will fit in the recipient’s bathtub and can safely meet all of the recipient’s bathing needs
  • • Details about the recipient’s current equipment, and why it is no longer meeting the recipient’s needs
  • • Other related equipment in use (mobility device, patient lift, etc.). Bath lift equipment may be considered a duplication of equipment if the recipient has a patient lift that can be used in the bathroom
  • • Other less costly ways to meet the recipient’s needs that have been considered and why they will not meet the recipient’s needs. Include details including make and model of multiple less costly items considered and rejected
  • • Evaluation by physical therapist/occupational therapist/other professional with experience evaluating bath and toilet equipment
  • Noncovered Services

  • • Bathtub wall rails
  • • Grab bars
  • • Hand-held shower units
  • • Modifications to bathrooms
  • • “Potty” chairs/seats for toilet training children
  • Authorization

    Authorization is required when requesting payment above the fee schedule rate as described above, for all commodes with electric seat lift mechanisms, for all seat lift mechanisms to be used with a toilet, for all bathtub lifts, and for all repairs where the submitted charge including parts and labor exceeds $400.

    When authorization is required, list all requested parts/accessories on the authorization request. If approved, the approved rate will include all requested and approved parts / accessories.

    Submit authorization requests through MN–ITS (authorization request 278). Fax the MN–ITS response with the required documentation, physician’s order, and Authorization Request for Bath/Shower/Toileting Equipment (DHS-6008) to the authorization medical review agent. Document the MN–ITS Authorization Request number assigned on every page of each document.

    For paper authorization, fax or mail the required documentation, physician’s orders and the MHCP Authorization (DHS-4695) form and Authorization Request for Bath/Shower/Toileting Equipment (DHS-6008) to the medical review agent.

    Attach the manufacturer’s invoice, a price list, or a quote from the manufacturer dated within three months of the authorization request.

    Billing

  • • Use MN–ITS 837P Professional. Refer to the MN–ITS User Guide for DME/Med Supply/Prosthetics/Orthotics for billing instructions
  • • Bill a pediatric commode using the appropriate Commode HCPCS code, and modifiers NU or RR and modifier U3 when appropriate. Do not use E1399
  • • Bill rehab shower commode chairs using the most appropriate bath/shower chair HCPCS code and modifiers NU or RR and modifier U3 when appropriate. Do not use E1399
  • • Bill bath lift equipment using the appropriate bath lift HCPCS code, and modifiers NU or RR and modifier U3 when appropriate. Do not use E1399
  • • Bill repairs using the HCPCS code of the item being repaired and modifier RB. The submitted charge must include all materials. Labor for repairs may be billed on a separate line
  • • The HCPCS code and modifiers must match the authorization
  • • It is not necessary to submit a claim to Medicare for denial if authorization was approved for purchase or repair of bath or toilet equipment that Medicare is known not to cover. If a claim for approved equipment is denied because it was not submitted to Medicare, contact the MHCP Provider Call Center to request a work order for review and possible payment.
  • Legal References

  • • MS 256B.0625 (Subd 31?)
  • • Minnesota Rules 9505.0310 (Medical Supplies and Equipment)
  • • Minnesota Rules 9505.0210 (Covered Services; General Requirements
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