C |
Product Name |
Covered/
Denied |
Explanation |
CANE |
C |
if the patient's condition impairs the patient's ability to walk.
In conjunction with a wheelchair
A cane can be covered in conjunction with a
wheelchair, if documented that the cane is required for in-home physical therapy. |
CATHETER |
C |
if the catheter is ordered by a physician as an integral to the operation of the patient's covered prosthetic device. See SUCTION CATHERTERS, FOLEY CATHETERS.
Tracheal catheter
is covered when ordered as an integral part of the patient's covered ventilator system. |
COLOSTOMY EQUIPMENT & SUPPLIES |
|
See OSTOMY EQUIPMENT AND SUPPLIES. |
COMMODE |
C |
if the patient is confined to a bed or a room, or confined to a floor without a toilet facility and the patient is incapable of utilizing regular toilet facilities.
Heavy Duty Commode
if the above conditions are met and the patient weighs in excess of 300 lb.. |
COMMODE W/REMOVABLE ARMS |
C |
if the criteria for a commode are met and the patient requires transfer or body configuration requires extra width. |
COMMUNICATOR |
D |
convenience item; not primarily medical in nature. |
CONCENTRATOR |
|
See OXYGEN SYSTEM. |
CONTINUOUS PASSIVE MOTION (CPM) DEVICE |
C |
if the patient has undergone a total knee replacement. To qualify for reimbursement, the device must be used within two days of surgery. Coverage in the home is
limited to a three-week period immediately following the surgery. |
CONTINUOUS POSITIVE AIRWAY PRESSURE EQUIPMENT (CPAP) |
C |
subject to the following conditions:
- the patient is diagnosed with moderate or severe Obstructive Sleep Apnea (OSA), and
- surgery is a likely alternative.
Diagnosis of Obstructive Sleep Apnea (OSA) must include documentation of a least 30 episodes of apnea, each lasting a minimum of 10 seconds, during 6-7 hours of recorded sleep.
Initial claims must
also certify that documentation supporting the diagnosis of OSA is available. |
CRUTCHES |
C |
if the patient's condition impairs the patient's ability to walk. |
CUSHION LIFT POWER SEAT |
|
See SEAT LIFT. |
