Toileting Aids

Affected Providers

Treating practitioners and DME suppliers who bill for commodes, bed pans, and urinals.

HCPCS & CPT Codes

Local Coverage Determination (LCD): Commodes (L33736) has the current HCPCS and CPT codes.

Background

You must meet the provisions in National Coverage Determination (NCD): Durable Medical Equipment Reference List (280.1). We outline other policy requirements in LCD L33736.

According to the 2024 Medicare Fee-for-Service Supplemental Improper Payment Data, the improper payment rate for commodes, bed pans, and urinals is 32.6%, with a projected improper payment amount of $2.5 million.

Denial Reasons

Insufficient documentation accounted for 42.5% of improper payments for commodes, bed pans, and urinals during the 2024 reporting period, while other errors (57.5%) also caused improper payments. “Other” errors include duplicate payment, non-covered or unallowable service, or ineligible Medicare patient errors.

Preventing Denials

Patients must meet these coverage conditions:

Commodes — We cover commodes if a patient is bed- or room-confined.

• A single room
• One level of the home environment with no toilet on that level
• A home with no toilet facilities

We cover:

•  An extra wide and heavy-duty commode chair (HCPCS code E0168) for patients who weigh 300 pounds or more
• A commode chair with detachable arms (HCPCS code E0165) if the detachable arms feature is necessary to transfer the patient or if the patient’s body requires extra width

Bed Pans (autoclavable hospital type) — We cover bed pans if a patient is bed-confined.

Urinals (autoclavable hospital type) — We cover urinals if a patient is bed-confined.

Documentation Requirements

To justify payment, you must meet specific requirements when ordering DMEPOS.