A commode is a portable toilet chair, typically placed next to a bed, that provides a safe and accessible toileting option for individuals who cannot easily or safely reach a standard bathroom. Medicare covers this equipment, but only when specific medical and situational requirements are met. The commode must be prescribed by a physician and classified as Durable Medical Equipment (DME) for use within the home, ensuring it is medically appropriate and not merely a matter of convenience.
Commode Coverage Under Medicare Part B
Commodes are classified by Medicare as Durable Medical Equipment (DME), meaning they can withstand repeated use, are used for a medical purpose, and are generally not useful to someone without an illness or injury. Coverage for commodes falls under Medicare Part B, which covers outpatient care and medical supplies. This coverage requires a physician’s prescription and use in the patient’s home. The “home” environment can include a private residence or a room in a facility like a skilled nursing facility, provided the facility is not already supplying the item as part of a covered stay.
The primary requirement for coverage is that the commode must be deemed “reasonable and necessary” for the patient’s condition. This medical necessity is satisfied when the patient is physically unable to use a regular toilet facility due to their illness or injury. Specifically, Medicare defines this inability by three main criteria concerning the patient’s confinement. The patient must either be confined to a single room, confined to a floor of their home where there is no toilet, or confined to their home where there are no toilet facilities at all.
The strict definition ensures the commode is not used as a substitute for items like a raised toilet seat, which Medicare generally does not cover. Standard commodes with fixed arms are typically the base model covered. Specialized versions may also be included if the medical need is documented, such as an extra wide or heavy-duty commode for patients weighing 300 pounds or more, or a commode with detachable arms necessary for patient transfer.
Patient Costs and Financial Responsibility
Even when a commode is covered by Medicare Part B, the beneficiary remains responsible for a portion of the cost. The commode is subject to the annual Part B deductible, which must be met before Medicare begins to pay for the item. Once the deductible is satisfied, the beneficiary is generally responsible for a 20% coinsurance of the Medicare-approved amount.
The total cost is influenced by whether the supplier “accepts assignment,” meaning they agree to accept the Medicare-approved amount as payment in full. If a supplier does not accept assignment, they can charge the beneficiary more than the standard 20% coinsurance, potentially increasing the patient’s financial burden.
Supplemental insurance, such as a Medigap policy or Medicaid, can help mitigate these remaining costs. A Medigap plan may cover some or all of the 20% coinsurance that the patient would otherwise owe. Patients should always verify with their supplier and secondary insurance plan to understand their specific financial liability before obtaining the commode.
Steps for Obtaining a Covered Commode
The process for obtaining a Medicare-covered commode begins with the treating physician. The doctor must document the patient’s physical limitations and the specific reasons why a commode is medically necessary in the patient’s chart notes. This documentation must explicitly state how the patient meets the confinement criteria established by Medicare.
The physician must then issue a Standard Written Order (SWO) for the commode, which serves as the official prescription. This order must include the patient’s name, the date of the order, a description of the item, and the physician’s signature. The supplier must receive this completed order before the claim is submitted to Medicare.
It is crucial that the commode is sourced from a supplier who is enrolled in and approved by Medicare. Before the item is delivered, the patient should confirm the supplier’s participation status and whether they accept assignment. Commodes are typically purchased outright by Medicare, unlike some other DME items that are rented. The supplier will submit the claim to Medicare, and once approved, the patient will be billed for their 20% coinsurance after the deductible has been met.