Therapeutic Chairs

Number: 0434

Policy

Note:

Aetna HMO plans (HMO, QPOS, Health Network Only, Health Network Option, and Medicare Advantage) do not cover the specialized therapeutic chairs, seats, and benches listed below regardless of whether or not the HMO member has a durable medical equipment (DME) benefit.  Aetna's HMO plans follow Medicare's coverage rules for these kinds of DME and Medicare does not cover these chairs as they are considered personal convenience items.

Aetna traditional plans (indemnity, PPO, and Managed Choice POS) consider specialized therapeutic chairs, seats, and benches medically necessary DME to enable the member to perform essential activities of daily living related to the member's health and hygiene, within or outside the home, with minimal or no assistance from others.

Aetna does not cover chairs, seats, and benches that are not mainly used to perform these essential daily activities, and/or which are normally of use to persons who do not have a disease or injury because they do not meet Aetna's contractual definition of covered DME.Footnotes for DME^*  Please check benefit plan descriptions for details.

The following specialized therapeutic chairs, seats, and benches are considered medically necessary DME by Aetna's traditional plans according to the selection criteria set forth below:

Specialized Therapeutic Chairs

• Total hip chairs and other raised therapeutic chairs:

  Total hip chairs and other therapeutic chairs with elevated seats enable members to sit without having to lower their body to the normal level of a regular chair.  Aetna traditional plans consider these chairs medically necessary DME for members with any of the following conditions:

  • Hip dislocation, or
  • Members with a hip spica cast, or
  • Total hip replacement.
    
    

  Note: Aetna HMO plans follow Medicare rules regarding total hip chairs or other raised therapeutic chairs.  Medicare considers total hip chairs or other raised therapeutic chairs non-covered personal convenience items.

• Auto tilt chairs:

  Auto tilt chairs, which can tilt forward, can be useful for members who have difficulty getting in and out of chairs.  Aetna's traditional plans consider auto tilt chairs medically necessary DME for members with impaired ability to raise or lower self due to physical handicap, disease, or injury.  Desk tilt chairs, which tilt backwards (not forwards), are considered non-covered personal convenience items. Note: 

  Aetna HMO plans follow Medicare rules regarding auto-tilt chairs; Medicare considers auto tilt chairs non-covered personal convenience items.

• Posture support chairs:

  Aetna's traditional plans consider posture support chairs medically necessary DME when they are needed to provide support for physically handicapped persons with impaired head and trunk control due to weakness or spasticity. Note: 

  Aetna's HMO plans follow Medicare rules for posture support chairs; Medicare considers posture support chairs non-covered personal convenience items.

• Transfer benches:

  Aetna's non-HMO plans consider transfer benches medically necessary DME where a physical handicap, disease, or injury inhibits the member's ability to raise or lower himself or herself. Note: 

  Aetna HMO plans follow Medicare rules regarding transfer benches; Medicare considers transfer benches non-covered personal convenience items.

• Rollabout chairs and chairs with casters:

  See CPB 0271 - Wheelchairs and Power Operated Vehicles (Scooters) 

Specialized Therapeutic Chairs Used Primarily for Children

• Corner chairs:

  Corner chairs are used primarily for children who, because of a handicap, need postural support while sitting on the floor.  Aetna traditional plans consider corner chairs medically necessary DME when needed to provide support for physically handicapped children. Note: 

  Aetna's HMO plans follow Medicare rules regarding chairs; Medicare considers corner chairs non-covered personal convenience items.

• Feeder seats:

  Feeder seats are soft foam seats with positioning straps that are used for feeding, resting, and other situations.  They are portable, and can be placed directly on the floor, in an adult's lap, or into a stroller.  Aetna's traditional plans consider feeder seats medically necessary DME for children, who, because of postural instability or weakness, need a chair with shoulder harnesses and shoulder straps to maintain their position while seated. Note: 

  Aetna's HMO plans follow Medicare rules regarding feeder seats; Medicare considers feeder seats non-covered personal convenience items.

• Carrie seats:

  Carrie seats are much like feeder seats, but have a rear strap, which allows them to be placed on a regular chair.  They also come with a headrest and adjustable footrest.  Aetna's traditional plans consider Carrie seats medically necessary DME for children, who, because of postural instability or weakness, need a chair with shoulder harnesses and shoulder straps to maintain their position while seated. Note: 

  Aetna's HMO plans follow Medicare rules; Medicare considers Carrie seats non-covered personal convenience items.

• Floor sitters:

  Floor sitters include a feeder seat (see above) and floor sitter wedge to hold the feeder seat upright.  Aetna's traditional plans consider floor sitters medically necessary DME for children, who, because of postural instability or weakness, need a chair with shoulder harnesses and shoulder straps to maintain their position while seated on the floor. Note: 

  Aetna's HMO plans follow Medicare rules regarding floor sitters; Medicare considers floor sitters non-covered personal convenience items.

• Versa form chair:

  The Versa form chair is a customizable, semi-permanent positioning support that is molded to the shape of the body.  Density and firmness are controlled by applying vacuum to the chair.  Aetna's traditional plans consider Versa form chairs medically necessary DME for children with postural instability who, because of a physical deformity, need a chair with postural support that conforms to the shape of their body. Note: 

  Aetna's HMO plans follow Medicare rules for Versa form chairs; Medicare considers Versa form chairs non-covered personal convenience items.

• Adjustable high chairs:

  Seats with adjustable depth, back, and footrest (e.g., Kaye Kinder chairs, Trip Trap chairs) may be useful for handicapped children with postural weakness or instability to provide stability and support, maintain body alignment, decrease the likelihood of postural deformities, and enhance hand use functions.  Chairs with adjustable back, depth, and footrest can function as a high chair for children with disabilities.  Children can be properly seated in thigh depth, back height, and foot support.  Aetna's traditional plans consider adjustable high chairs medically necessary DME for children who, because of a physical handicap, deformity, or weakness, are unable to use a standard high chair and need an adjustable high chair. Note: 

  Aetna's HMO plans follow Medicare rules for adjustable high chairs; Medicare considers these adjustable high chairs non-covered personal convenience items.

Footnotes^* Note: The following are examples of chairs that are not covered DME because they are not mainly used in the treatment of disease or injury, are not primarily medical in nature, and/or are normally of use to persons who do not have a disease or injury:

• Back rests
• Lumex Ortho-Biotic High Back Rocker
• Lumex Ortho-Biotic Recliner
• Maddapult Assisto-Seat
• Massage chairs
• Safety car seats
• Standard (non-adjustable) high chairs
• Standard feeder seats without positioning straps
• Zero gravity chairs.

For policy on wheelchairs, see CPB 0271 - Wheelchairs and Power Operated Vehicles (Scooters).

Background

Therapeutic chairs are specialized seating systems that are adapted to accommodate persons with a physical handicaps.  Therapeutic chairs may be necessary to allow persons with disabilities to perform transfers or other essential daily activities, or to facilitate their optimal positioning.

Table: CPT Codes / HCPCS Codes / ICD-10 Codes

Code	Code Description
Information in the [brackets] below has been added for clarification purposes.   Codes requiring a 7th character are represented by "+":
HCPCS codes covered if selection criteria are met:
E0162	Sitz bath chair
E0163	Commode chair, mobile or stationary, with fixed arms
E0165	Commode chair, mobile or stationary, with detachable arms
E0168	Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each
E0170 (for Traditional plans)	Commode chair with integrated seat lift mechanism, electric, any type
E0171 (for Traditional plans)	Commode chair with integrated seat lift mechanism, non-electric, any type
E1570	Adjustable chair, for ESRD patients
HCPCS codes not covered for indications listed in the CPB:
E0170 (for HMO plans)	Commode chair with integrated seat lift mechanism, electric, any type
E0171 (for HMO plans)	Commode chair with integrated seat lift mechanism, non-electric, any type
E0240	Bath/shower chair, with or without wheels, any size
E0245	Tub stool or bench
E0247	Transfer bench for tub or toilet with or without commode opening
E0248	Transfer bench, heavy duty, for tub or toilet with or without commode opening
ICD-10 codes covered if selection criteria are met (not all-inclusive):
M84.750+ - M84.750+	Atypical femoral fracture
S72.001+ - S72.26x+, S79.001+ - S79.019+	Fracture of head and neck of femur
S73.001+ - S73.046+	Subluxation and dislocation of hip
Z96.641 - Z96.649	Presence of artificial hip joint

The above policy is based on the following references: