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Every policy word on this page is CMS's own. Verzi adds pins, receipts, and links only.

E0175

Commodes

LCD L33736 · CMS's HCPCS descriptor for E0175: Foot rest, for use with commode chair, each.

Not on CMS's Required Prior Authorization List for DMEPOS on 2026-10-13. source

LCD L33736 · 8 versions, 2015 to today · last changed 2020-01-01 (R7)

Version 5 of LCD L33736: in force by CMS's dates 2015-10-01 to 2016-06-30. The policy text on this page comes from this archived version. On its start date, 2015-10-01, the companion Article in force was Article A52461 version 5.

DME MAC jurisdictions
JA · Noridian 16013
CT, DE, DC, ME, MD, MA, NH, NJ, NY, PA, RI, VT
JB · CGS 17013
IL, IN, KY, MI, MN, OH, WI
JC · CGS 18003
AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, PR, SC, TN, TX, VI, VA, WV
JD · Noridian 19003
AK, AS, AZ, CA, GU, HI, ID, IA, KS, MO, MT, NE, NV, ND, MP, OR, SD, UT, WA, WY
source

CMS's Who are the MACs jurisdiction pages (DME facts as of 2025-09-30) name each contractor and its states; the MCD's Contractor Information table on every DME LCD prints the contract numbers. Both read 2026-10-09. Verzi adds the state lookup only.

You are viewing version 5 (2015-10-01 to 2016-06-30). Version 20 is in force today.

Codes CMS lists in this LCD's current version (version 20, 9 codes). CMS's download carries no list for version 5: E0163 E0165 E0167 E0168 E0170 E0171 E0172 E0175 E0244

Sections in this version: CMS National Coverage Policy · Coverage Indications, Limitations, and/or Medical Necessity · Coding Information · Associated Information · Sources of Information and Basis for Decision. Plus 3 sections marked N/A in this version.

Full verbatim text serves to customers · Customer? Log in

Version history, LCD L33736

CMS numbers each version. Each box shows the version's window by CMS's stated dates. Select a version to show it on this page. Versions superseded the same day they took effect never governed a claim, so the page hides them until you ask. Version numbers CMS never published to its archive do not exist as documents.

Revision history, every version

CMS's own change log, quoted, 7 entries. It does not change with the version shown. A revision (R-number) is a change CMS logged. The version (vN) is the snapshot that carries it.

R7 · 2020-01-01 · v20
Revision Effective Date: 01/01/2020
CODING INFORMATION:
Removed: Field titled “Bill Type”
 Removed: Field titled “Revenue Codes”
Removed: Field titled “ICD-10 Codes that Support Medical Necessity”
Removed: Field titled “ICD-10 Codes that DO NOT Support Medical Necessity”
Removed: Field titled “Additional ICD-10 Information”


As required by CR 10901, the ICD-10 information has been moved to all Policy Articles. There is no change in coverage.
R6 · 2020-01-01 · v18
Revision Effective Date: 01/01/2020
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Order information as a result of Final Rule 1713
GENERAL DOCUMENTATION REQUIREMENTS:
Revised: Prescriptions (orders) to SWO


02/13/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.
R5 · 2017-01-01 · v12
Revision Effective Date: 01/01/2017
COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Removed: Standard Documentation Language
Added: New reference language and directions to Standard Documentation Requirements
Added: General Requirements
DOCUMENTATION REQUIREMENTS:
Removed: Standard Documentation Language
Added: General Documentation Requirements
Added: New reference language and directions to Standard Documentation Requirements
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Removed: Standard Documentation Language
Added: Direction to Standard Documentation Requirements
Removed: PIM reference under Appendices
Removed: Supplier Manual Reference under Miscellaneous
RELATED LOCAL COVERAGE DOCUMENTS:
Added: LCD-related Standard Documentation Requirements article
R4 · 2016-07-01 · v9
Revision Effective Date: 07/01/2016
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language Effective 04/28/2016
R3 · 2016-07-01 · v7
Effective July 1, 2016 oversight for DME MAC LCDs is the responsibility of CGS Administrators, LLC 18003 and 17013 and Noridian Healthcare Solutions, LLC 19003 and 16013. No other changes have been made to the LCDs.
R2 · 2015-10-01 · v5
Revision Effective Date:  10/31/2014 (August 2015 Publication)
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Added:  Incorporated NCD 280.1 coverage statement regarding bidets, bidet toilet seats and similar
R1 · 2015-10-01 · v3
Revision Effective Date: 10/31/2014
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary’s Medicare eligibility
DOCUMENTATION REQUIREMENTS:
Deleted: Reference to refill of supplies from Continued Use
Revised: Standard Documentation Language to add who can enter date of delivery date on the POD
Added: Instructions for Equipment Retained from a Prior Payer
Revised: Repair to beneficiary-owned DMEPOS
Receipts for auditors

Version 5 of LCD L33736, shown on this page: in force by CMS's dates 2015-10-01 to 2016-06-30. Archived 2026-09-26. CMS's copy · Our archived file. 8 of 8 sections are proven word-identical to the archived file.

Every archived version of LCD L33736 (8 versions, CMS's dates, window by the as-of rule).

DocumentVersionIn forceArchived onVerify
LCD L33736version 22015-10-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33736version 32015-10-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33736version 5 shown2015-10-01 to 2016-06-302026-09-26CMS's copy · Our archived file
LCD L33736version 72016-07-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33736version 92016-07-01 to 2016-12-312026-09-26CMS's copy · Our archived file
LCD L33736version 122017-01-01 to 2019-12-312026-09-26CMS's copy · Our archived file
LCD L33736version 182020-01-01, superseded same day2026-10-09CMS's copy · Our archived file
LCD L33736version 202020-01-01 to today2026-09-26CMS's copy · Our archived file

The related Articles each have their own receipts: Article A55426 · Article A52461.

Each archived file's page gives its sha256 fingerprint. A copy of the file hashes to the same value, byte for byte.

CMS's live page shows only the current version. To check a passage by eye, open CMS's copy of the same version number. A version's window ends on the earlier of CMS's stated end date and the day before the next version starts.

Every policy word on this page is CMS's, from the archived version named beside it. Verzi adds labels, highlights, citations and links only. Verzi-written summary content on this page: none.

Governing policies, as CMS lists them:

  • LCD L33736 · Commodes
    CMS lists E0175 in group 1 of version 20. CMS's description, quoted: “FOOT REST, FOR USE WITH COMMODE CHAIR, EACH”.
    Related Articles, as CMS lists them: Article A55426 · Article A52461

From CMS's LCD code table. HCPCS Level II codes only.

source

CMS's LCD code table in the Medicare Coverage Database download, archived 2026-10-09: Our archived file.

Watch E0175

One email when any policy cited for E0175 changes or gains a future effective date. Nothing else, ever.