P |
Product Name |
Covered/
Denied |
Explanation |
PARAFFIN BATH (PORTABLE) |
C |
is covered when the patient has undergone a successful trial period of paraffin therapy, and long-term use will relieve the patient's condition.A PHYSICIAN'S
PRESCRIPTION MUST BE FURNISHED TO THE SUPPLIER PRIOR TO DELIVERY. NOT COVERED
Institutional paraffin bath units |
PARALLEL BARS |
D |
support exercise item; primarily for institutional use. |
PATIENT LIFT |
C |
if the patient requires transfer between bed and a chair, wheelchair, or commode that requires the assistance of more than one person and without the use of the lift,
the patient would be bed confined. |
PORTABLE OXYGEN SYSTEM |
|
see OXYGEN SYSTEM (PORTABLE). |
POSITIVE PRESSURE VENTILATOR |
|
see VENTILATOR. |
POWER WHEELCHAIR |
|
See WHEELCHAIR. |
POWER OPERATED VEHICLE (POV) |
C |
if deemed medically necessary by a specialist in physical medicine, orthopedic surgery, neurology or rheumotology for patients with the following conditions:
- used within the confines of the patient's home
- without the use of a wheelchair he/she would otherwise be bed or chair confined, and
- unable to operate a manual wheelchair, and
- capable of safely operating control of the POV, and
- can safely transfer in and out of the POV and
- has adequate trunk stability to be able to safely ride in the POV
NOT COVERED
if primarily used for ambulating outside of the patient's home. A PHYSICIAN'S PRESCRIPTION MUST BE FURNISHED TO THE SUPPLIER PRIOR TO DELIVERY. ==> Prior authorization is available. |
PRESSURE LEOTARDS |
D |
non reuseable supply; not rental-type item. |
PRESSURE RELIEF MATTRESS |
|
see ALTERNATING PRESSURE MATTRESS. |
PRESSURE REDUCING MATTRESS
(includes all flotation devices: air, water, gel, etc.) |
C |
If the patient meets:
- criterion 1, or
- criteria 2 or 3 and at least one of the criteria 4 through 7
- Completely immobile - i.e. patient cannot make changes in body position without assistance.
- Limited mobility - i.e. patient cannot independently make changes in body position significant enough to alleviate pressure.
- Any stage pressure ulcer on the trunk or pelvis.
- Impaired nutritional status.
- Fecal or urinary incontinence.
- Altered sensor perception.
- Compromised circulatory status.
A PHYSICIAN'S PRESCRIPTION MUST BE FURNISHED TO THE SUPPLIER PRIOR TO DELIVERY. |
