Commodes - Coverage and Coding Clarification
When the seat pan of a commode is removed, the device can be placed over a toilet and serve as a raised toilet seat. However, if the device is only used in this way, the general coverage criteria of the Commodes policy are not met and the device is noncovered. In this situation, the appropriate HCPCS code for the commode is used and a GY modifier is added to the code and the KX modifier is not used. This will result in a denial as statutorily noncovered - no benefit category.
A commode with seat lift mechanism is a free-standing device that has a commode pan and that has an integrated seat that can be raised with or without a forward tilt while the patient is seated. An integrated device is one which is sold as a unit by the manufacturer and in which the lift and the commode cannot be separated without the use of tools. Code E0169 may only be used for those devices that have an electric seat lift mechanism. Code E1399 must be used for a commode chair with an integrated non-electric seat lift mechanism. A commode with seat lift mechanism is intended to allow the patient to walk after standing. If the patient can ambulate, he/she would rarely meet the coverage criterion for a commode. Therefore if the patient is capable of walking from the bed to the bathroom, a KX modifier must not be added to the code for the commode with seat lift mechanism.
These changes will be incorporated into the Commodes policy in a future revision.
Published by Palmetto GBA as the SADMERC, May 2005. Republished by Noridian as the PDAC, August 2008. Republished by Palmetto GBA as the PDAC, January 2019.