A seat lift mechanism (E0627, E0628, E0629) is considered medically necessary and eligible for reimbursement when ordered by the treating physician and ALL of the following criteria are met:

1. The patient must have severe arthritis of the hip or knee or have a severe neuromuscular disease.
2. The seat lift mechanism must be prescribed to effect improvement or to arrest or retard deterioration in the patient’s condition.
3. The patient must be completely incapable of standing up from a regular armchair or any chair in their home.
4. Once standing, the patient must have the ability to ambulate.

Coverage of seat lift mechanisms is limited to those types that operate smoothly, can be controlled by the patient, and effectively assist a patient 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 patient from a seated to a standing position are not covered. A participating, preferred, or network provider can bill the member for the denied seat lift.

The medical necessity for the seat lift mechanism must be documented in the patient’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.

Coverage is limited to the seat lift mechanism, even if it is incorporated into a chair. When providing a seat lift mechanism that is incorporated into a chair as a complete unit at the time of purchase, suppliers must bill the item using established code E0627. In this situation, the supplier may bill code E0627 for the seat lift mechanism and A9270 for the chair. However, if the seat lift mechanism, electric or non-electric, is supplied as an individual unit to be incorporated into a chair that a patient owns, the supplier must bill using the appropriate code for the seat lift mechanism for use with patient owned furniture (E0628 or E0629).

Description

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

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Seat and chair lifts (E0627, E0628, E0629) do not meet the criteria for durable medical equipment, and are therefore not eligible for benefits.

DME MAC Jurisdiction A L11533