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 not medically necessary.
The medical necessity for the seat lift mechanism must be documented in the individual’s medical record and must be available upon request.
In addition, an order for each item billed must be signed and dated by the treating physician, kept on file by the supplier, and made available upon request. In order for payment to be made, this order must be received by the supplier prior to delivery of the item.
Seat lift mechanisms that do not meet the criteria of this policy will be considered not medically necessary.
Procedure Codes