Seat Lift Mechanisms

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

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

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-49-013

Section: Durable Medical Equipment

Effective Date: March 01, 2020

Revised Date: November 30, 2020

Revision Effective Date: January 04, 2021

Last Reviewed: November 19, 2020

Archived Date: January 02, 2022

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 severe 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 that do not meet the criteria of this policy are considered not medically necessary.

Procedure Codes

E0627

E0628

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.

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.

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