S |
Product Name |
Covered/
Denied |
Explanation |
SAUNA BATH |
D |
not primarily medical in nature. |
SCOOTER |
|
see POWER OPERATED VEHICLE. |
SEAT LIFT |
C |
if prescribed by a physician for patients with severe arthritis of the hip or knee, muscular dystrophy, or some other neuromuscular disease and use of the device
benefits the patient therapeutically.
If medical necessity and the following conditions exist:
- the patient must have severe arthritis of the hip or knee or have a sever neuromuscular disease.
- the seat lift mechanism must be a part of the physician's course of treatment and be prescribed to effect improvement, or arrest or retard deterioration in the patient's condition.
- The patient must be completely incapable of standing up from a regular armchair or any chair in their home. (The fact that a patent has difficulty or is even incapable of getting up from a chair,
particularly a low chair, is not sufficient justification for a seat lift mechanism.)
- once standing, the patient must have the ability to ambulate.
NOT COVERED
if used in conjunction with a covered wheelchair. A seat lift that operates using a spring release mechanism with a sudden, cataput-like motion that jolts the patient from a seated
to a standing position. Also, if the seat lift uses a recliner feature, this feature will not be covered. A physician's prescription must be furnished to the supplier prior to delivery.
==> Prior authorization is available. |
SPHYGMOMANO METER WITH CUFF |
|
see BLOOD PRESSURE MONITOR. |
SPHYGMOSTAT |
|
see BLOOD PRESSURE MONITOR. |
STAIRGLIDE |
D |
convenience item; not primarily medical in nature. |
STETHOSCOPE |
C |
if prescribed by a physician as part of a home hemodialysis system. |
SUCTION CATHETERS |
C |
if a suction pump is supplied to the patient. Only if used for deep tracheostomy suctioning. Oropharyngeal Suction Catheter
as a replacement item only
when used with a medically necessary suction pump owned by the patient. Utilization Limits
- three sterile catheters per day
- three oropharyngeal suction catheters per week
- 30 day supply for each prospective billing month
|
SUCTION MACHINE |
C |
if patient has difficulty raising and clearing secretions secondary to any of the following conditions:
- cancer or surgery of the throat or mouth
- dysfunction of the swallowing muscles
- unconsciousness or obtunded state
- tracheostomy
|
SURGICAL DRESSINGS |
C |
if primary and secondary dressings as long as medically necessary for one of the following treatments:
- a wound caused by a surgical procedure performed by a physician (or other health care professional)
- a wound after reasonable and necessary debridement (irregardless of type) by a health care professional.
NOT COVERED
supplies used for debridement and cleaning the wound |
SURGICAL LEGGINGS |
D |
non reusable disposable supply; not rental-type item. |
