Non-Covered Services

Jump To...

• Cranial Electrotherapy Stimulator (CES)

The following list of non-covered services is not all-inclusive:

1. Air conditioners
2. Bathroom scales
3. Bathtub wall rails
4. Beds – oscillating and lounge beds, bed baths and lifters, bedboards, tables, and other bed accessories
5. Blood glucose analyzer – reflectance colorimeter
6. Car seats, standard use
7. Cervical roll, or pillow clothing
8. Control units and battery device adapters
9. Dehumidifiers – room or central
10. Diathermy machines
11. Disposable wipes – including Attends wash cloths
12. Disposable ice packs/disposable heat wraps
13. Enclosed beds for members with one-on-one caregiver supervision 24 hours per day
14. Elevators and stair lifts
15. Enuresis or bed-wetting alarms
16. Environmental products (e.g., air filters, purifiers, conditioners, hypoallergenic bedding, and linens)
17. Exercise equipment
18. Food blenders
19. Grab bars
20. Heat and massage foam cushion pads
21. Home security systems
22. Household equipment and supplies such as ramps, switches, tableware, and feeding instruments
23. Hoyer converters that convert a manual lift into an electric lift
24. Humidifiers – room type or central
25. Hygiene supplies and equipment, including hand-held shower units and shower trays, and dental care supplies and equipment
26. Ice packs (disposable)
27. Incontinence undergarments (includes pants to wear with pads)
28. Instructional materials (e.g., pamphlets and books)
29. Isolation gowns, surgical gowns, and masks
30. Items of convenience including but not limited to the following items coded as A9270:
    1. Bags
    2. Baskets
    3. Canopies
    4. Clothing guards
    5. Cup or bottle holders
    6. Identification devices or license plates
    7. Lighting systems
    8. Pouches
    9. Snow tires
    10. Speed conversion kits
31. Leg cycle ergonometry (e.g., StimMaster, ERGYS, REGYS, RT300 motorized FES Ergometer)
32. Magnifying glasses
33. Massage devices
34. Medical alert bracelets and response systems
35. Medical supplies defined as drugs
36. Menses products (e.g., sanitary pads)
37. Motorized lifts for vehicle
38. Orthopedic mattresses
39. Personal computers and printers, tape recorders, or video recorders
40. Pulse tachometers
41. Ramps
42. Reachers
43. Reading glasses
44. Reusable bed or chair pads
45. Saline or other solutions for the care of contact lenses
46. Swim diapers
47. Table foods
48. Telephones, telephone alert systems, telephone arms, or answering machines
49. Tennis/gym shoes
50. Thermometer covers
51. Toothbrushes and toothettes
52. Toys
53. Waterbeds
54. White canes for the blind

Cranial Electrotherapy Stimulator (CES)

This is not covered as it is considered investigative for all conditions.

PW_11-19_539
Updated_09/08/2025