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.