Does E0172 require prior authorization?

No, E0172 does not require prior authorization (high confidence). Covered without prior authorization.

`E0172`, Seat lift mechanism placed over or on top of toilet, any type

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted.
For DMEPOS base items requiring a Written Order Prior to Delivery (WOPD), the supplier must have received a signed WOPD before the item is delivered to the beneficiary.
For DMEPOS base items that require a WOPD and also have separately billed associated options/accessories/supplies, the WOPD must list the base item and may list the separately billed items prior to delivery.
Suppliers are required to maintain proof of delivery (POD) documentation in their files and make it available to the Medicare contractor upon request.

Commode is covered when the beneficiary is physically incapable of utilizing regular toilet facilities.
Commode is covered when the beneficiary is confined to a single room and cannot access regular toilet facilities.
Commode is covered when the beneficiary is confined to one level of the home and there is no toilet on that level.
Commode is covered when the beneficiary is confined to the home and there are no toilet facilities in the home.
Extra wide/heavy duty commode chair (HCPCS E0168) is covered when the beneficiary weighs 300 pounds or more.
Commode chair with detachable arms (HCPCS E0165) is covered when detachable arms are necessary to facilitate transferring the beneficiary or when the beneficiary's body configuration requires extra width.

ANTHEM-CG-DME-25, Seat Lift Mechanisms

L33736, Commodes

L33801, Seat Lift Mechanisms

AETNA-CPB-0429, Bathroom and Toilet Equipment and Supplies

AETNA-CPB-0459, Seat Lifts and Patient Lifts

Ask Backwork about documentation requirements, denial risks, or coverage in your state.