CurrentAetnaPolicy 0429

Bathroom and Toilet Equipment and Supplies

Defines Aetna's coverage and medical necessity criteria for bathroom and toilet durable medical equipment (DME) and supplies for members under HMO-based/health network plans and traditional plans.

Policy Summary

PayerAetna

PolicyBathroom and Toilet Equipment and Supplies

Policy CodePolicy 0429

Change TypeNo material change

Effective DateJul 13, 2000

Next Review DateApr 25, 2024

Key ActionProvide clinical documentation supporting confinement status, inability to transfer or bathe without seating, and member weight when requesting bariatric equipment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

HMO vs TraditionalCoverage distinctions by plan type

>=300 lbBariatric threshold

22 codesHCPCS codes listed

IncludedRoom-confined definition

Coverage Criteria for Bathroom and Toilet DME

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Plan type rule: HMO-based and health network plans generally follow Medicare and consider most bathroom DME personal convenience items; Traditional plans may cover items that are primarily medical in nature.

See plan-specific table and footnotes

Commode medical necessity: Member is physically incapable of using regular toilet facilities AND (member is bed-confined OR room-confined OR confined to one level of the home with no toilet on that level OR confined to the home with no toilet facilities).

Mobile commode chairs may be used as alternatives to stationary commodes when criteria are met

Extra wide/heavy commode: Member weighs 300 pounds or more.>= 300 lb

Width >= 23 inches

Commode chair with detachable arms: Detachable arms are necessary to facilitate transfer or the member's body configuration requires extra width.

Commode used as raised toilet seat (Traditional plans): Member is unable to rise from a toilet seat without assistance.

HMO-based/health network plans consider raised toilet seats personal convenience items and do not cover when used as a raised toilet seat

Commode with seat lift mechanism: Member meets medical necessity for a commode and meets medical necessity criteria for a seat lift per CPB 0459; device intended to allow walking after standing and is rarely appropriate if the member can ambulate.

Read with CPB 0459 - Seat Lifts and Patient Lifts

Many bathroom aids and accessories are considered personal convenience items or are explicitly noncovered under Aetna's HMO-based/health network plans. Examples called out in the policy include footrests, grab bars affixed to the wall, hand‑held showers, bidet toilet seats, whirlpools, sauna baths, bath mats, and a range of other bath/shower accessories. The policy distinguishes items that may be covered under Traditional plans from those that Medicare and HMO‑based plans treat as non‑medical convenience items; check plan type when determining coverage.

Aetna's HMO‑based and health network plans follow Medicare and consider raised toilet seats to be personal convenience items. Consequently, raised toilet seats are not medically necessary and are not covered under HMO‑based/health network plans, though Traditional plans may cover them when the Traditional plan criteria are met.

Medical Necessity Rules

DME medical necessity criteria

Medical necessity for specific bathroom DME items when ALL/ANY as shown:

Bed- or room-confined for commodes/bedpans/urinals: Member is bed-confined OR room-confined (leaving the room is medically contraindicated) OR confined to one level of the home with no toilet on that level OR confined to the home with no toilet facilities.

Footnote 1; accessibility of bathroom generally not a factor

Infection or injury to perineal area: Items such as sitz baths are considered medically necessary for infection or injury of the perineal area.

Footnote 2

Unable to bathe without seating: Bathing seats, shower chairs, and benches are medically necessary if the member is unable to bathe or shower without being seated.

Footnote 3

Unable to transfer to/from tub or rise from toilet: Bathtub transfer aids and toilet seat lifts are considered when the member is unable to transfer to and from the tub or unable to rise from a toilet seat without assistance.

Footnotes 4 and 5

Extra wide/heavy commode selection: Member weighs greater than or equal to 300 pounds or requires a commode width of at least 23 inches.>= 300 lb

Definition: extra wide/heavy commode

HCPCS Codes and Coding Rules

HCPCS codes listed (covered if selection criteria met)HCPCS

E0160	Sitz type bath or equipment, portable, used with or without commode.
E0161	Sitz type bath or equipment, portable, used with or without commode, with faucet attachment(s).
E0162	Sitz bath chair.
E0163	Commode chair, mobile or stationary, with fixed arms.
E0165	Commode chair, mobile or stationary, with detachable arms.
E0167	Pail or pan for use with commode chair, replacement only.
E0168	Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each.
E0170	Commode chair with integrated seat lift mechanism, electric, any type.
E0171	Commode chair with integrated seat lift mechanism, non-electric, any type.
E0172	Seat lift mechanism placed over or on top of toilet, any type.

1–10 of 22

1/3

HCPCS codes listed as not covered for HMO-based plans or specific noncovered itemsHCPCSNot Covered

E0170	Commode chair with integrated seat lift mechanism, electric, any type. (not covered for HMO-based plans)
E0171	Commode chair with integrated seat lift mechanism, non-electric, any type. (not covered for HMO-based plans)
E0172	Seat lift mechanism placed over or on top of toilet, any type. (not covered for HMO-based plans)
E0175	Foot rest, for use with commode chair, each. (not covered)
E0240	Bath/shower chair, with or without wheels, any size. (not covered for HMO-based plans)
E0241	Bathtub wall rail, each. (not covered)
E0242	Bathtub rail, floor base. (not covered)
E0243	Toilet rail, each. (not covered)
E0244	Raised toilet seat. (not covered for HMO-based plans)
E0245	Tub stool or bench. (not covered for HMO-based plans)

1–10 of 18

1/2

inv-06: Weight threshold for extra wide/heavy commode — >= 300 pounds

Weight threshold>= 300 pounds

Width referenceUsed with extra wide/heavy commode definition (width >= 23 inches)

Clinical justification requiredMember weight must be documented when requesting bariatric/extra wide commode

Provider Actions, Prior Authorization, and Documentation

Prior Authorization

Plan-dependent prior authorization and coverage

Certain HCPCS are covered or noncovered depending on plan type. HMO and health-network based plans follow Medicare rules and may treat some items (for example, raised toilet seats and some bath/shower items) as non-covered personal convenience items. Prior authorization may be required by the member's plan for specific HCPCS (e.g., commode seat lift mechanisms and some bath/shower items). Providers should verify plan type and prior authorization requirements before ordering or billing.

Examples of plan-dependent items: E0170, E0171, E0172, E0240, E0244, E0245, E0247, E0248, E0625 (see HCPCS lists).
HMO-based plans: Medicare-based rules may render raised toilet seats and commode used as raised toilet seats non-covered.

Denial Risk

Noncovered HCPCS for HMO-based plans

Providers must be aware that certain HMO-based plans will deny items listed as noncovered when billed under those plans. When billing for HMO/health network based members, do not expect coverage for HCPCS explicitly listed as not covered for HMO-based plans.

Commonly not covered for HMO-based plans: E0170, E0171, E0172, E0240, E0241, E0242, E0243, E0244, E0245, E0247, E0248, E0625, E1300–E1310.
If an item is noncovered for the member's plan type, submiters should anticipate denial and follow appeal or alternative equipment pathways as applicable.

Documentation Required

Clinical documentation to justify medical necessity

Document clinical indications that justify medical necessity for the requested bathroom or toilet equipment. Include objective evidence of the member’s limitation and any device-specific criteria (for example, weight for extra wide/heavy commodes or criteria from the seat lift policy).

Support room- or bed-confinement status when applicable (definition: member medically unable to leave room; or confined to one level of home with no toilet on that level; or confined to home with no toilet facilities).
If requesting extra wide/heavy commode, document member weight (>= 300 pounds) and body configuration.
When requesting commode with integrated seat lift mechanism, include documentation that member meets commode criteria and the medical necessity criteria in CPB 0459 (Seat Lifts and Patient Lifts).
Describe the member's inability to transfer or bathe without the equipment and any prior conservative measures tried.

Billing Rule

Provider billing note

Provider billing note: follow plan-specific coding and coverage guidance. Footrests are not considered covered DME. A free-standing raised toilet seat supported by legs is treated as a commode. Verify whether codes are restricted to Traditional plans versus HMO-based plans before submitting claims.

Footrests do not meet Aetna’s contractual definition of covered DME and should not be billed as DME (E0175 example).
Free-standing raised toilet seats supported by legs are considered commodes (bill commode codes where appropriate).
Confirm code applicability by plan type: some codes (e.g., E0240, E0244, E0245, E0247, E0248, E0625) are listed as covered only for Traditional plans and not for HMO-based plans.

Rental and Purchase Rules

Item	Rule
Commode with seat lift mechanism	Coverage depends on plan and medical necessity. Seat lift mechanisms incorporated into a commode chair are medically necessary only when the member meets medical necessity criteria for a commode chair and meets medical necessity criteria for a seat lift per CPB 0459. A commode with integrated lift is intended to allow walking after standing; if the member can ambulate, they would rarely meet criteria.
Seat lift mechanism (toilet-mounted)	Coverage and whether purchase or rental applies vary by plan. Follow plan-specific rental/purchase rules and read with CPB 0459 for seat lift medical necessity and billing guidance.

Item

Rule

Commode with seat lift mechanism

Coverage depends on plan and medical necessity. Seat lift mechanisms incorporated into a commode chair are medically necessary only when the member meets medical necessity criteria for a commode chair and meets medical necessity criteria for a seat lift per CPB 0459. A commode with integrated lift is intended to allow walking after standing; if the member can ambulate, they would rarely meet criteria.

Seat lift mechanism (toilet-mounted)

Coverage and whether purchase or rental applies vary by plan. Follow plan-specific rental/purchase rules and read with CPB 0459 for seat lift medical necessity and billing guidance.

Documentation Requirements

Documentation Required

Provide clinical justification tied to listed footnote criteria

Tie clinical justification explicitly to the policy footnote criteria: document bed- or room-confinement, inability to transfer or bathe without seating, and any infection/injury of the perineal area or weight criteria as indicated.

State which footnote criterion applies (e.g., bed- or room-confined, unable to bathe unless seated, infection of perineal area).
For extra wide/heavy commodes, include measured weight (>= 300 lb) and need for width >= 23 inches.

Definitions

inv-12: Extra wide/heavy commode chair — definition and dimensional/weight threshold.

DefinitionA commode with width >= 23 inches and capable of supporting a person who weighs 300 pounds or more.

TypesStationary or mobile; with or without arms; extra wide and/or heavy duty.

Clinical indicationMedically necessary for members who weigh 300 pounds or more and who meet commode medical necessity criteria.

DocumentationMember weight and need for extra width must be documented to justify bariatric commode selection.

inv-13: Raised toilet seat — definition (adds height to toilet seat; fixed or adjustable; free-standing with legs etc.).

DefinitionDevice that adds height to the toilet seat; may be fixed height or adjustable; may be attached to the toilet or unattached and resting on the bowl.

Free-standing variantA free-standing raised toilet seat supported by legs on the floor is considered a commode.

Plan considerationViewed as a personal convenience item by HMO-based/health network plans (may be not medically necessary under those plans).

inv-14: Toilet seat lift mechanism — definition (device attached to toilet raising seat to assist patient to stand; may tilt).

DefinitionDevice attached to the toilet with a seat that can be raised with or without a forward tilt while the patient is seated to assist the patient to stand and ambulate once upright.

OperationMay be manually operated or electric.

Clinical purposeIntended to assist a patient who is unable to rise from a toilet seat without assistance or to facilitate transfer to standing when medically necessary.

inv-15: Commode with integrated seat lift mechanism — definition (free-standing commode sold as a unit with integrated lift not separable without tools).

DefinitionFree-standing commode sold as a single unit that includes an integrated lift (seat that can be raised with or without forward tilt) and a commode pan; the lift and commode cannot be separated without the use of tools.

DistinctionDistinct from toilet-mounted seat lift mechanisms which attach to the toilet; integrated commode is sold as one unit.

Equipment classificationConsidered a commode with seat lift mechanism and evaluated against commode and seat lift medical necessity criteria (read with CPB 0459).

Items Not Covered

Items specifically listed as not covered or treated as noncovered personal convenience items include: footrests; grab bars affixed to the wall; hand‑held showers; bath mats; bidet toilet seats; whirlpools and pumps (portable and nonportable); sauna baths; and many other bath and shower accessories. Several HCPCS codes corresponding to these items (for example, codes such as E0170–E0172, E0240, E0244, E0247–E0248, and E0625) are identified in the policy as not covered for HMO‑based plans and will be denied when billed under those plans.

Background

Bathing and toileting are essential activities of daily living. The policy notes that many bathroom DME items are considered personal convenience by Medicare and Aetna's HMO‑based/health network plans; therefore coverage depends on plan type (HMO‑based/health network versus Traditional) and on specific clinical criteria. Medical necessity determinations require documentation supporting confinement status (bed‑ or room‑confined), inability to transfer or bathe without seating, presence of infection or injury when relevant, and weight when requesting bariatric or extra wide/heavy equipment. Because plan rules differ, always verify the member’s plan type and follow the stated medical necessity criteria and related policy CPB references (for example, CPB 0459 for seat lifts).