Summary & Overview
HCPCS Level II E0167: Pail or Pan for Commode Chair, Replacement Only
HCPCS Level II code E0167 denotes a replacement pail or pan for use with a commode chair. As a narrowly defined durable medical equipment (DME) supply, this code matters nationally because it enables standardized billing for a common replacement accessory that supports patient toileting needs in home and long-term care settings. Accurate coding affects coverage decisions, supply procurement, and patient access to needed aids.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise profile of the code’s clinical purpose, typical sites of service, and how it fits within DME billing workflows. The report outlines common payer coverage patterns and billing considerations for replacement DME parts, presents benchmarkable elements for contracting and claims processing, and summarizes relevant policy nuances that influence reimbursement and claims adjudication nationally. Where specific payer policy details or benchmarking data are not present in the input, the report notes that those data are not available.
Billing Code Overview
HCPCS Level II code E0167 describes a pail or pan for use with a commode chair, replacement only. This item is classified as durable medical equipment intended solely as a replacement component for a commode chair. The service type is durable medical equipment — commode accessory replacement, and the typical site of service is home or long-term care settings where a commode chair is used by a patient. Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an elderly adult with limited mobility due to advanced osteoarthritis, stroke-related hemiparesis, or frailty who uses a bedside commode or commode chair at home or in a long-term care facility. The commode chair requires a removable pail or pan for collection of urine and stool. The durable medical equipment supplier replaces a worn, cracked, or missing E0167 pail/pan when requested by the patient, caregiver, or nursing staff.
The clinical workflow: a clinician (primary care physician, geriatrician, or nursing facility medical director) documents the medical necessity for a commode and replacement parts in the patient record, including applicable diagnosis codes (e.g., mobility impairment, weakness, or incontinence). The supplier receives a prescription or order specifying replacement of the commode pail/pan (E0167), verifies eligibility with the patient’s payor, obtains any required prior authorization, dispenses the replacement pail, and bills the appropriate payor using E0167 with applicable modifiers and the documented diagnosis codes in the claim.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) |