Seat Lift Mechanisms

Policy ID: E-49-015

Section: Durable Medical Equipment

Effective Date: March 01, 2020

Revised Date: April 10, 2024

Revision Effective Date: July 07, 2024

Last Reviewed: May 13, 2025

Applies To: Commercial and Medicaid Expansion

Description

Seat lift mechanisms are designed to assist individuals to stand from a sitting position. Seat lifts can be built into chairs or can be separate for use with other furniture.

Policy Application

All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.

Criteria

Coverage is subject to the specific terms of the member's benefit plan.

Seat lift mechanisms may be considered medically necessary when ALL of the following are met:

Ordered by the treating physician; and
Prescribed to effect improvement or to attest or retard deterioration in the individual's condition; and
Individual has severe arthritis of the hip or knee or has a moderate neuromuscular disease; and
Individual is completely incapable of standing up from a regular armchair or any chair in their home; and
Once standing, the individual must have the ability to ambulate.

Coverage of seat lift mechanisms is limited to those types that meet ALL of the following:

Operates smoothly; and
Can be controlled by the individual; and
Effectively assist an individual in standing up and sitting down without other assistance.

Seat lifts that operate by spring release mechanism with a sudden, catapult-like motion and jolt the individual from a seated to a standing position are considered not medically necessary.

Seat lift mechanisms not meeting the criteria as indicated in this policy are considered not medically necessary.

Procedure Codes

E0627

E0629

Diagnosis Codes

Covered Diagnosis Codes for Procedure Codes E0627; E0629

G10

G12.20

G12.21

G12.22

G12.23

G12.24

G12.25

G20

G20.B2

G35

G70.00

G70.01

G70.1

G70.2

G70.80

G70.81

G70.89

G73.1

G73.3

M05.551

M05.552

M05.561

M05.562

M05.651

M05.652

M05.661

M05.662

M05.751

M05.752

M05.761

M05.762

M12.151

M12.152

M12.161

M12.162

M12.551

M12.552

M12.561

M12.562

M12.851

M12.852

M12.861

M12.862

M13.851

M13.852

M13.861

M13.862

M15.0

M15.1

M15.2

M15.3

M15.4

M15.8

M16.0

M16.11

M16.12

M16.2

M16.31

M16.32

M16.4

M16.51

M16.52

M16.6

M16.7

M17.0

M17.11

M17.12

M35.3

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 1-22-2020

Removed reimbursement language

Internal Medical Policy Committee 11-19-2020

Removed two (2) statements about documenting Med necessity.
Removed procedure code A9270.

Internal Medical Policy Committee 11-23-2021

Updated clarifying language.

Internal Medical Policy Committee 11-29-2022 Annual review-no changes in criteria

Internal Medical Policy Committee 3-23-2023 Coding update - Effective May 01, 2023

Removed procedure code E0628.

Internal Medical Policy Committee 5-14-2024 Annual review-no changes in criteria

Added Policy Application; and
Added Diagnosis codes G10; G12.20; G12.21; G12.22; G12.23; G12.24; G12.25; G20; G20.B2; G35; G70.00; G70.01; G70.1; G70.2; G70.80; G70.81; G70.89; G73.1; G73.3; M05.551; M05.552; M05.561; M05.562; M05.651; M05.652; M05.661; M05.662; M05.751; M05.752; M05.761; M05.762; M12.151; M12.152; M12.161; M12.162; M12.551; M12.552; M12.561; M12.562; M12.851; M12.852; M12.861; M12.862; M13.851; M13.852; M13.861; M13.862; M15.0; M15.1; M15.2; M15.3; M15.4; M15.8; M16.0; M16.11; M16.12; M16.2; M16.31; M16.32; M16.4; M16.51; M16.52; M16.6; M16.7; M17.0; M17.11; M17.12; M35.3.

Internal Medical Policy Committee 5-13-2025 Annual review-no changes in criteria

Links

References (PDF)

Disclaimer

Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically.

Policy ID: E-49-014

Section: Durable Medical Equipment

Effective Date: March 01, 2020

Revised Date: February 26, 2023

Revision Effective Date: May 01, 2023

Last Reviewed: March 23, 2023

Archived Date: June 30, 2024

Applies To: Commercial and Medicaid Expansion

Description

Seat lift mechanisms are designed to assist individuals to stand from a sitting position. Seat lifts can be built into chairs or can be separate for use with other furniture.

Criteria

Seat lift mechanisms may be considered medically necessary when ALL of the following are met:

Ordered by the treating physician; and
Prescribed to effect improvement or to attest or retard deterioration in the individual’s condition; and
Individual has severe arthritis of the hip or knee or has a moderate neuromuscular disease; and
Individual is completely incapable of standing up from a regular armchair or any chair in their home; and
Once standing, the individual must have the ability to ambulate.

Coverage of seat lift mechanisms is limited to those types that meet ALL of the following:

Operates smoothly; and
Can be controlled by the individual; and
Effectively assist an individual in standing up and sitting down without other assistance.

Seat lifts that operate by spring release mechanism with a sudden, catapult-like motion and jolt the individual from a seated to a standing position are considered not medically necessary.

Seat lift mechanisms not meeting the criteria as indicated in this policy are considered not medically necessary.

Procedure Codes

E0627

E0629

Diagnosis Codes

Not Applicable

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 1-22-2020

Removed reimbursement language

Internal Medical Policy Committee 11-19-2020

Removed two (2) statements about documenting Med necessity.
Removed procedure code A9270.

Internal Medical Policy Committee 11-23-2021

Updated clarifying language.

Internal Medical Policy Committee 11-29-2022 Annual review-no changes in criteria

Internal Medical Policy Committee 3-23-2023 Coding update - Effective May 01, 2023

Removed procedure code E0628

Links

References (PDF)

Disclaimer

Our Partners in Health:
Members
Employers
Producers

Fargo (Headquarters)
4510 13th Ave. S.
Fargo, N.D., 58121

Medical Policies Quick Search

Seat Lift Mechanisms

Description

Policy Application

Criteria

Procedure Codes

Diagnosis Codes

Professional Statements and Societal Positions Guidelines

ND Committee Review

Links

Disclaimer

Description

Criteria

Procedure Codes

Diagnosis Codes

Professional Statements and Societal Positions Guidelines

ND Committee Review

Links

Disclaimer