CMNs & Materials

FORMS

VPC requires both a prescription/CMN and medical records to
process prescriptions for coverage

Prescriptions/CMN: Need to be detailed with specific items and quantities listed. Abstract categories such as "incontinence supplies" will not be accepted and will cause delays.

Medical Records: These are doctor visit notes, hospital stays, home care evaluations that are signed and completed by a licensed healthcare provider. They assist determine medical necessity of items that are prescribed/ordered. Prescriptions submitted without valid medical records will have processing delays. This includes 'unsigned' notes, notes 'awaiting cosign', illegible medical records, and letters attesting to a patient needs such items.

Equipment.

Walkers, Bath Equipment, Bp Monitors ...

Equipment Coverage Matrix	Medicare	Medi-Cal
Bath Seat/Chair	Not Covered	Covered
Bath Tub Rail	Not Covered	Covered
Canes	Covered	Covered
Grab Bars	Not Covered	Covered
Commode	Covered*	Covered
Toilet Seat Riser	Not Covered	Covered
Transfer Bench	Not Covered	Covered
Walkers**	Covered	Covered

* Patient must meet one of the following criteria for Medicare to cover a commode:

a) Patient is confined to a single room
or
b) Patient is confined to one level of the home environment and there is no toilet available
or
c) Patient is confined to the home and there are no toilets available

** VPC only accepts prescriptions for front wheeled walkers

Automatic BP Monitor
CMN

Coverage Criteria:
- Patient must have HTN for routine coverage noted in their medical record

- Only covered by CCAH.

Bath equipment
CMN

Coverage Criteria:
- Patient must have mobility issues noted in their medical record

Sliding Transfer bench
CMN

Coverage Criteria:
- Patient must have mobility issues noted in their medical record
- Reasons for non-standard item need to be clearly noted in patient's chart.
- Items are non-standard and will require TAR

wALKER/cANE
CMN

Coverage Criteria:
- Patient must have mobility issues noted in medical record

Incontinence.

Diapers, Pullups, Creams, Washes, Wipes, Gloves ...

- Only CCAH, Medi-Cal, and VA cover incontinence supplies.

- VPC only accepts CCAH and Medi-Cal patients. VA patients need to obtain supplies through the VA system.

- Medicare does NOT cover incontinence supplies.

- Private insurance typically follow Medicare guidelines. Patients need to consult with their private insurance for coverage.

incontinence supplies (adult)
CMN

Coverage Criteria:
- Medical condition causing incontinence needs to be noted in patient's medical record
- Type of Incontinence needs to be noted in patient's medical record

incontinence supplies (child)
CMN

Coverage Criteria:
- Medical condition causing incontinence needs to be noted in patient's medical record
- Type of Incontinence needs to be noted in patient's medical record

wipes/gloves
CMN

Coverage Criteria:
- Medical condition causing incontinence needs to be noted in patient's medical record
- Type of Incontinence needs to be noted in patient's medical record

*Wipes/Gloves require additional authorization once CMN and medical notes are received by VPC.