Non-Covered Items
The following items are considered convenience items, comfort items, hygienic equipment or not primarily medical in nature, and are non-covered.
Description |
Code |
Adjustable high chair |
T5001 |
Auto-Tilt Chair |
T5001 |
Backrests |
E1399 |
Batteries, Replacement |
A4630 |
Bathtub Lifts, Whirlpool tub, walk-in, portable |
E0265, E1300, K1003 |
Bathtub/Shower chairs/seats |
E0240, E0245, E0247, E0248 |
Bath tub Rail, Wall Rail |
E0241, E0242, E0243, E0246 |
Carafes |
E1399 |
Carrie seats |
T5001 |
Corner chair |
T5001 |
Ear Plugs (standard or custom-made) |
E1399 |
Electric Adaptors (for car, truck, etc.) |
E1399 |
Elevators |
E1399 |
Enema/Enema Bags |
A4458 |
Enuresis (Bed Wetting) Alarm |
S8270 |
Exercise Equipment, Exercycle |
A9300 |
Feeder seats |
T5001 |
Floor sitters |
T5001 |
Grab Bars |
E0241, E0242, E0243, E0246 |
Heavy Cast Socks-6 |
E1399 |
Hot Water Bottle, ice cap or collar, heat and/or cold wrap, any type (includes ice pack) |
A9273 |
Hygienic equipment |
A9286 |
Hygienic supply |
A9286 |
Light Cast Sock-6 |
E1399 |
Linen, nonallergenic |
E1399 |
Lumbar Roll |
E0190 |
Lumex Ortho-Biotic High Back Rockers |
E1399 |
Lumex Ortho-Biotic Recliners |
E1399 |
Massage Chair/Robotic Chair |
E1399 |
Massage Devices |
E1399 |
Massage Mattress |
E1399 |
Massage Table |
E1399 |
Mileage |
E1399 |
Mobile Monomatic Sanitation System |
E1399 |
Niagara Massage Pillow |
E1399 |
Niagara Thermo-Cyclopad |
E1399 |
Positioning cushion/pillow/wedge, any shape or size |
E0190 |
Positioning Support System |
T5001 |
Posture support chair |
T5001 |
Raised Toilet Seats |
E0244 |
Reaching/Grabbing device, any type, any length, each |
A9281 |
Safety car seats |
E1399 |
Sauna Baths |
E1399 |
Silverware/Utensils |
E1399 |
Standard feeder seats |
T5001 |
Standard high chairs |
T5001 |
Telephone Arms |
E1399 |
Toilet Seats |
E1399 |
Treadmill Exerciser |
A9300 |
Tub rail attachment |
E0246 |
Tub Stool or Bench |
E0240, E0245, E0247, E0248 |
Versa Form chairs |
T5001 |
Zero gravity chair |
E1399 |
The following items are considered environmental control equipment and are non-covered.
Description |
Code |
Air Cleaners |
E1399 |
Air Conditioners |
E1399 |
Dehumidifiers |
E1399 |
Environmental control equipment |
E1399 |
Heating and Cooling Plants |
E1399 |
Humidifiers |
E1399 |
Portable Room Heaters |
E1399 |
The following items are considered educational equipment; and are not primarily medical in nature and are non-covered.
Description |
Code |
Braille Teaching Texts |
E1399 |
Communic-Aid |
E1902 |
Communicator |
E1902 |
The following items are considered inappropriate for home use or physician instruments or institutional equipment and are non-covered.
Description |
Code |
Esophageal Dilator |
E1399 |
American Bidet Toilet Seat |
E1399 |
Aquamatic K-Thermia |
E0217, E0236, E0249 |
Diathermy Machines, Low frequency ultrasonic diathermy treatment device for home use, includes all components and accessories |
E0761, K1004 |
Hydrocollator Heating Unit |
E0225, E0239 |
Intermittent Traction Unit |
E1399 |
Paraffin Bath Units – non-portable |
E1399 |
Parallel Bars |
E1399 |
Translift Chair |
E1399 |
The following items are considered non-reusable disposable supplies and are non-covered.
Description |
Code |
Disposable Sheets and Bags |
E1399 |
Incontinence Supplies and Incontinence garments and underpads |
A4520, A4554, T4521, T4522, T4523, T4524, T4525, T4526, T4527, T4528, T4529, T4530, T4531, T4532, T4533, T4534, T4535, T4536, T4537, T4538, T4539, T4540, T4541, T4542, T4543, T4544 |
Delivery, Setup and Service A9901 is non-covered as this is included in the service.
Telephone Alert Systems, E1399 are considered emergency communications systems and do not serve a diagnostic or therapeutic purpose and are therefore non-covered.