Medicare Coverage
| Air Cleaners | Deny--environmental control equipment; not primarily medical in nature |
| Air Conditioners | Deny--environmental control equipment; not primarily medical in nature. |
| Air-Fluidized Bed | Covered, if medically necessary (Not currently offered by Keystone Mobility) |
| Alternating Pressure Pads, Mattresses and Lambs Wool Pads | Covered if patient has, or is highly susceptible to, decubitus ulcers and the patient's physician specifies that he/she has specified that he will be supervising the course of treatment. |
| Audible/Visible Signal/Pacemaker Monitor | (See Self-Contained Pacemaker Monitor.) |
| Augmentative Communication Device | (See Speech Generating Devices) |
| Bathtub Lifts | Deny--convenience item; not primarily medical in nature. |
| Bathtub Seats | Deny--comfort or convenience item; hygienic equipment; not primarily medical in nature. |
| Bed Baths (home type) | Deny--hygienic equipment; not primarily medical in nature. |
| Bed Lifter(bed elevator) | Deny--not primarily medical in nature. |
| Bedboards | Deny--not primarily medical in nature. |
| Bed Pans (autoclavable hospital type) | Covered if patient is bed confined. |
| Bed Side Rails | Covered only where hospital bed is medically necessary. |
| Beds-Lounge(power or manual) | Deny--not a hospital bed; comfort or convenience item; not primarily medical in nature. |
| Beds--Oscillating | Deny--institutional equipment; inappropriate for home use. |
| Bidet Toilet Seat | (See Toilet Seats.) |
| Blood Glucose Analyzer -- Reflectance Colorimeter | Deny--unsuitable for home use |
| Blood Glucose Monitor | Covered if patient meets certain conditions. (Not currently offered by Keystone Mobility) |
| Braille Teaching Texts | Deny--educational equipment; not primarily medical in nature |
| Canes | Covered if patient meets Mobility Assistive Equipment clinical criteria. |
| Carafes | Deny--convenience item; not primarily medical in nature. |
| Catheters | Deny--nonreusable disposable supply. |
| Commodes |
Covered if patient is confined to bed or room. NOTE: The term "room confined" means that the patient's condition is such that leaving the room is medically contraindicated. The accessibility of bathroom facilities generally would not be a factor in this determination. However, confinement of a patient to a home in a case where there are no toilet facilities in the home may be equated to room confinement. Moreover, payment may also be made if a patient's medical condition confines him to a floor of the home and there is no bathroom located on that floor. |
| Communicators | (See Speech Generating Devices) |
| Devices | Continuous passive motion devices are devices Covered for patients who have received a total knee replacement. To qualify for coverage, use of the device must commence within 2 days following surgery. In addition, coverage is limited to that portion of the >3-week period following surgery during which the device is used in the patient's home. There is insufficient evidence to justify coverage of these devices for longer periods of time or for other applications. (Not Currently offered by Keystone Mobility) |
| Continuous Positive Airway Pressure (CPAP)Devices | Covered if patient meets specific criteria (Not offered by Keystone Mobility) |
| Crutches | Covered if patient meets Mobility Assistive Equipment clinical criteria |
| Cushion Lift Power Seat | (See Seat Lifts.) |
| Dehumidifiers (room or central heating system type) | Deny--environmental control equipment; not primarily medical in nature. |
| Diathermy Machines (standard pulses wave types) | Deny--inappropriate for home use. |
| Digital Electronic Pacemaker Monitor | (See Self-Contained Pacemaker Monitor) |
| Disposable Sheets and Bags | Deny--nonreusable disposable supplies |
| Elastic Stockings | Deny--nonreusable supply; not rental-type items. |
| Electric Air Cleaners | Deny--(See Air Cleaners.) |
| Electric Hospital Beds | (See Hospital Beds) |
| Electrical Stimulation for Wounds | Deny--inappropriate for home use. |
| Electrostatic Machines | Deny--(See Air Cleaners and Air Conditioners.) |
| Elevators | Deny--convenience item; not primarily medical in nature. |
| Emesis Basins | Deny--convenience item; not primarily medical in nature. |
| Esophageal Dilator | Deny--physician instrument; inappropriate for patient use. |
| Exercise Equipment | Deny--not primarily medical in nature. |
| Fabric Supports | Deny--nonreusable supplies; not rental-type items. |
| Face Masks (oxygen) | Covered if oxygen is covered. (Not currently offered by Keystone Mobility) |
| Face Masks (surgical) | Deny--nonreusable disposable item. |
| Flowmeter | (See Medical Oxygen Regulators.) |
| Fluidic Breathing Assister | (See Intermittent Positive Pressure Breathing Machines.) |
| Fomentation Devices | (See Heating Pads.) |
| Gel Flotation Pads and Mattresses | (See Alternating Pressure Pads and Mattresses.) |
| Grab Bars | Deny--self-help device; not primarily medical in nature. |
| Heat and Massage | Deny--not primarily medical in nature; personal comfort item. |
| Heating and Cooling Plants | Deny--environmental control equipment not primarily medical in nature. |
| Heating Pads | Covered if the contractor's medical staff determines patient's medical condition is one for which the application of heat in the form of a heating pad is therapeutically effective. |
| Heat Lamps | Covered if the contractor's medical staff determines patient's medical condition is one for which the application of heat in the form of a heat lamp is therapeutically effective. |
| Hospital Beds | Covered if patient meets specific criteria |
| Hot Packs | (See Heating Pads.) |
| Humidifiers (oxygen) | (See Oxygen Humidifiers.) |
| Humidifiers (room or central heating system types) | Deny--environmental control equipment; not medical in nature. |
| Hydraulic Lift | (See Patient Lifts.) |
| Incontinent Pads | Deny--nonreusable supply; hygienic item. |
| Infusion Pumps | For external and implantable pumps, see §40.2 of the NCD Manual. If the pump is used with an enteral or parenteral nutritional therapy system. (Not currently offered by Keystone Mobility) |
| Injectors (hypodermic jet | Deny--not covered self-administered drug supply; pressure powered devices for injection of insulin. |
| Intermittent Positive Pressure Breathing Machines | Covered if patient's ability to breathe is severely impaired. (Not currently offered by Keystone Mobility) |
| Iron Lungs | (See Ventilators.) |
| Irrigating Kit | Deny--nonreusable supply; hygienic equipment. |
| Lambs Wool Pads | (See Alternating Pressure Pads, Mattresses, and Lambs Wool Pads.) |
| Leotards | Deny--(See Pressure Leotards.) |
| Lymphedema Pumps | Covered - (Not currently offered by Keystone Mobility) |
| Massage Devices | Deny--personal comfort items; not primarily medical in nature. |
| Mattress | Covered only where hospital bed is medically necessary. (Separate Charge for replacement mattress should not be allowed where hospital bed with mattress is rented.) |
| Medical Oxygen Regulators | Covered if patient's ability to breathe is severely impaired. (Not currently offered by Keystone Mobility) |
| Mobile Geriatric Chairs | Covered if patient meets Mobility Assistive Equipment clinical criteria. |
| Motorized Wheelchairs | Covered if patient meets Mobility Assistive Equipment clinical criteria. |
| Muscle Stimulators | Covered for certain conditions. (Not currently offered by Keystone Mobility) |
| Nebulizers | Covered if patient's ability to breathe is severely impaired. (Not currently offered by Keystone Mobility) |
| Oscillating Beds | Deny--institutional equipment - inappropriate for home use. |
| Overbed Tables | Deny--convenience item; not primarily medical in nature. |
| Oxygen | Covered if the oxygen has been prescribed for use in connection with medically necessary >DME (Not currently offered by Keystone Mobility) |
| Oxygen Humidifiers | Covered if the oxygen has been prescribed for use in connection with medically necessary >DME for purposes of moisturizing oxygen. (Not currently offered by Keystone Mobility) |
| Oxygen Regulators (Medical) | (See Medical Oxygen Regulators.) |
| Paraffin Bath Units (Portable) | (See Portable Paraffin Bath Units.) |
| Paraffin Bath Units (Standard) | inappropriate for home use. |
| Parallel Bars | Deny--support exercise equipment; primarily for institutional use; in the home setting other devices (e.g., walkers) satisfy the patient's need. |
| Patient Lifts | Covered if contractor's medical staff determines patient's condition is such that periodic movement is necessary to effect improvement or to arrest or retard deterioration in his condition. |
| Percussors | Covered for mobilizing respiratory tract secretions in patients with chronic obstructive lung disease, chronic bronchitis, or emphysema, when patient or operator of powered percussor receives appropriate training by a physician or therapist, and no one competent to administer manual therapy is available. (Not currently offered by Keystone Mobility) |
| Portable Oxygen Systems |
1. Regulated Covered (adjustable Covered under conditions specified in a flow rate). Refer all claims to medical staff for this determination. (Not currently offered by Keystone Mobility) 2. Preset Deny (flow rate Deny emergency, first-aid, or not adjustable) precautionary equipment; essentially not therapeutic in nature. (Not currently offered by Keystone Mobility) |
| Portable Paraffin Bath Units | Covered when the patient has undergone a successful trial period of paraffin therapy ordered by a physician and the patient's condition is expected to be relieved by long term use of this modality. |
| Portable Room Heaters | Deny--environmental control equipment; not primarily medical in nature. |
| Portable Whirlpool Pumps | Deny--not primarily medical in nature; personal comfort items. |
| Postural Drainage Boards | Covered if patient has a chronic pulmonary condition. (Not currently offered by Keystone Mobility) |
| Preset Portable Oxygen Units | Deny--emergency, first-aid, or precautionary equipment; essentially not therapeutic in nature. |
| Pressure Leotards | Deny--non-reusable supply, not rental-type item. |
| Pulse Tachometers | Deny--not reasonable or necessary for monitoring pulse of homebound patient with or without a cardiac pacemaker. |
| Quad-Canes | Covered if patient meets Mobility Assistive Equipment clinical criteria |
| Raised Toilet Seats | Deny--convenience item; hygienic equipment; not primarily medical in nature. |
| Reflectance Colorimeters | (See Blood Glucose Analyzers.) |
| Respirators | (See Ventilators.) |
| Rolling Chairs | Covered if patient meets Mobility Assistive Equipment clinical criteria Coverage is limited to those roll-about chairs having casters of at least 5 inches in diameter and specifically designed to meet the needs of ill, injured, or otherwise impaired individuals. Coverage is denied for the wide range of chairs with smaller casters as are found in general use in homes, offices, and institutions for many purposes not related to the care/treatment of ill/injured persons. This type is not primarily medical in nature. |
| Safety Roller | Covered if patient meets Mobility Assistive Equipment clinical criteria. |
| Sauna Baths | Deny--not primarily medical in nature; personal comfort items. |
| Scooters/POV | (See Wheelchair - Scooter/POV) |
| Seat Lift | Covered under the specific conditions. |
| Self Contained Pacemaker Monitor | Covered when prescribed by a physician for a patient with a cardiac pacemaker. (Not currently offered by Keystone Mobility) |
| Sitz Bath | Covered if the contractor's medical staff determines patient has an infection or injury of the perineal area and the item has been prescribed by the patient's physician as a part of his planned regimen of treatment in the patient's home. |
| Spare Tanks of Oxygen | Deny--convenience or precautionary supply. |
| Speech Teaching Machine | Deny--education equipment; not primarily medical in nature. |
| Stairway Elevators | Deny--(See Elevators.) |
| Standing Table | Deny--convenience item; not primarily medical in nature. |
| Steam Packs | These packs are Covered under the same conditions as heating pads. (See Heating Pads.) |
| Suction Machine | Covered if the contractor's medical staff determines that the machine specified in the claim is medically required and appropriate for home use without technical or professional supervision. (Not currently offered by Keystone Mobility) |
| Support Hose | Deny (See Fabric Supports.) |
| Surgical Leggings | Deny--non-reusable supply; not rental-type item. |
| Telephone Alert Systems | Deny--these are emergency communications systems and do not serve a diagnostic or therapeutic purpose. |
| Toilet Seats | Deny--not medical equipment. |
| Traction Equipment | Covered if patient has orthopedic impairment requiring traction equipment >that prevents ambulation during the period of use (Consider covering devices usable during ambulation; e.g., cervical traction collar, under the brace provision). (Not currently offered by Keystone Mobility) |
| Trapeze Bars | Covered if patient is bed confined and the patient needs a trapeze bar to sit up because of respiratory condition, to change body position for other medical reasons, or to get in and out of bed. |
| Treadmill Exerciser | Deny--exercise equipment; not primarily medical in nature. |
| Ultraviolet Cabinet | Covered for selected patients with generalized intractable psoriasis. Using appropriate consultation, the contractor should determine whether medical and other factors justify treatment at home rather than at alternative sites, e.g., outpatient department of a hospital. (Not currently offered by Keystone Mobility) |
| Urinals autoclavable | Covered if patient is bed confined hospital type. (Not currently offered by Keystone Mobility) |
| Vaporizers | Covered if patient has a respiratory illness. |
| Ventilators | Covered for treatment of neuromuscular diseases, thoracic restrictive diseases, and chronic respiratory failure consequent to chronic obstructive pulmonary disease. Includes both positive and negative pressure types. (Not currently offered by Keystone Mobility) |
| Walkers | Covered if patient meets Mobility Assistive Equipment clinical criteria. |
| Water and Pressure Pads and Mattresses | (See Alternating Pressure Pads, Mattresses and Lamb Wool Pads.) |
| Wheelchairs (manual) | Covered if patient meets Mobility Assistive Equipment clinical criteria. |
| Wheelchairs (power operated) | Covered if patient meets Mobility Assistive Equipment clinical criteria. |
| Wheelchairs (Scooter/POV) | Covered if patient meets Mobility Assistive Equipment clinical criteria. |
| Wheelchairs (specially-sized) | Covered if patient meets Mobility Assistive Equipment clinical criteria. |
| Whirlpool Bath Equipment | Covered if patient is homebound and has a (standard) condition for which the whirlpool bath can be expected to provide substantial therapeutic benefit justifying its cost. Where patient is not homebound but has such a condition, payment is restricted to the cost of providing the services elsewhere; e.g., an outpatient department of a participating hospital, if that alternative is less costly. In all cases, refer claim to medical staff for a determination. (Not currently offered by Keystone Mobility) |
| Whirlpool Pumps | Deny--(See Portable Whirlpool Pumps.) |
| White Cane | (Not considered Mobility Assistive Equipment) |