Local Coverage Determination · DME MAC
L33736
Commodes
Version 20. CMS effective date 01/01/2020. CMS updated 02/13/2020. Read from the CMS Coverage API on 2026-10-13. Contractors on the report: CGS Administrators (DME MAC) and Noridian Healthcare Solutions (DME MAC).
CMS coverage policy citation. CMS Publication 100-03 Medicare National Coverage Determinations Manual, Chapter 1, Section 280.1
Coverage indication
In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement: The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section. The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section. Refer to the Supplier Manual for additional information on documentation requirements. Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD. For the items addressed in this LCD, the “reasonable and necessary” criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity. A commode is covered when the beneficiary is physically incapable of utilizing regular toilet facilities. This would occur in the following situations: The beneficiary is confined to a single room, or The beneficiary is confined to one level of the home environment and there is no toilet on that level, or The beneficiary is confined to the home and there are no toilet facilities in the home. An extra wide/heavy duty commode chair (E0168) is covered for a beneficiary who weighs 300 pounds or more. If an E0168 commode is ordered and the beneficiary does not weigh more than 300 pounds, it will be denied as not reasonable and necessary.
Excerpt from the LCD indication. Full text on CMS.
Documentation requirements
Items covered in this LCD have additional policy-specific requirements that must be met prior to Medicare reimbursement. Refer to the LCD-related Policy article, located at the bottom of this policy under the Related Local Coverage Documents section for additional information.
Related articles
- A55426 · Standard Documentation Requirements for All Claims Submitted to DME MACs
- A52461 · Commodes - Policy Article
Related NCDs
- NCD 280.1 · Durable Medical Equipment Reference List (version 4)
HCPCS codes on this LCD
Questions
What does LCD L33736 cover?
L33736 is Commodes. It is a current final DME MAC local coverage determination, version 20.
Where is the CMS source for L33736?
The Medicare Coverage Database page for LCD L33736 version 20.
Get the signed answer via API
The signed answer is the receipt for this code on a date of service: the rule that was in force, with a hash you can replay. The call needs an API key. The source archive and as-of resolution are public.
curl -H "X-API-Key: $VERZI_API_KEY" \
"https://api.verzi.health/v1/rules/warrant?hcpcs=E0163&as_of=2024-01-15&npi=1234567890&state=UT"