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Aetna Aetna
Clinical Policy Bulletin:
Seat Lifts and Patient Lifts
Number: 0459


Policy

Seat Lifts:

Aetna considers seat lift mechanisms medically necessary durable medical equipment (DME) when all of the following criteria are met:

  1. The member must be incapable of standing up from a regular armchair at home; and
  2. The member must have severe arthritis of the hip or knee, or have severe neuromuscular disease; and
  3. The seat lift mechanism must be prescribed to effect improvement, or arrest or retard deterioration in the member's condition; and
  4. Once standing, the member must have the ability to ambulate.

Aetna considers seat lift mechanisms experimental and investigational for all other indications because of insufficient evidence in the peer-reviewed literature.

Medically necessary seat-lift mechanisms are those types that operate smoothly, can be controlled by the member, and effectively assist the member in standing up and sitting down without other assistance.  Seat lifts that operate by spring release mechanism with a sudden, catapult-type motion that jolts the member from a seated to a standing position, are considered experimental and investigational because of insufficient evidence in the peer-reviewed literature.

Note: Coverage is limited to the seat-lift mechanism, even if it is incorporated into a chair.

Patient Lifts:

Aetna considers patient lifts medically necessary DME if transfer between bed and a chair, wheelchair, or commode requires the assistance of more than 1 person and, without the use of a lift, the member would be bed-confined.  Patient lifts are considered experimental and investigational for all other indications because of insufficient evidence in the peer-reviewed literature.

Examples of brands of medically necessary patient lifts are the Hoyer Lift, the Lift-Aid Chamber Lift and the Trans-Aid Lift.

Notes: Aetna's HMO plans follow Medicare's rules for lift mechanisms, and consider bathroom or toilet patient lifts non-covered convenience items as Medicare considers bathroom and toilet equipment to be convenience items.  Aetna's traditional plans consider bathroom or toilet patient lifts medically necessary for members who meet the criteria for patient lifts set forth above.

Aetna considers an electric lift mechanism a non-covered convenience feature.

Non-covered Lifts:

Note: Aetna does not cover the following types of lifts because they do not meet Aetna's contractual definition of covered DME:

  • Van lifts (used to lift wheelchair into a truck or van)
  • Wheelchair lifts or ramps (e.g., Wheel-O-Vator lift) (provides access to stairways or car trunks). 

Aetna does not cover the following types of lifts because they are considered home modifications:

  • Ceiling lifts (patient lifts mounted on tracks that are attached to the ceiling)
  • Platform lifts, stair lifts, and stairway elevators.

Repairs:

See Appendix for medically necessary units of service for common repairs to seat lifts and patient lifts.

Aetna considers a canvas or nylon sling or seat for a hydraulic/mechanical lift medically necessary as an accessory when ordered as a replacement for the original equipment item.

Aetna considers a multi-positional transfer system medically necessary when the member meets criteria for a standard manual standard transfer device and has a medical condition requiring a supine transfer.

Aetna considers a standard, non-powered, standing device medically necessary when the following criteria are met

  • The member is unable to ambulate or stand independently because of a neuromuscular condition but has sufficient residual strength in the lower extremities (e.g., hip and legs) to allow for use of the device; and
  • A standing position cannot be successfully achieved even with the use of physical therapy or other assistive devices; and
  • The member has completed appropriate standing device training and has demonstrated an ability to safely use the device; and
  • Use of the device is expected to allow meaningful improvement in at least one of the following:
     
    •  Circulatory, digestive, excretory or respiratory function; or
    • Functional head and trunk control; or
    • Functional use of the arms or hands; or
    • Performance of activities of daily living; or
    • Skin integrity, by off-loading weight through standing (e.g., relief of pressure sores not achievable by other means)

For electric, motorized, or powered standing devices, see CPB 0271 - Wheelchairs and Power Operated Vehicles (Scooters).



Background

This policy was adapted from Medicare Durable Medical Equipment Carrier (DMERC) medical policies on seat lift mechanisms and patient lifts.

A multi-positional transfer system is used to assist the caregiver in transferring an individual who requires the use of a lift along with supine positioning for transfer.  Multi-positional transfer systems (e.g., Barton Convertible H-250 Chair, Barton Medical Corporation, Austin, TX) are intended to facilitate an independent and safe transfer for the caregiver and individuals who have medical conditions that precludes the use of a standard transfer device (i.e., hydraulic/mechanical lift).

Appendix

The following table contains repair units of service allowances that are considered medically necessary for common repairs to seat lifts and patient lifts.  Units of service include basic trouble-shooting and problem diagnosis.

Type of Equipment Part Being Repaired/Replaced Allowed Units of Service (UOS)
Seat Lift Hand Control

2

Seat Lift Scissor mechanism

3

Patient Lift Hydraulic pump

2

Key: One unit of service = 15 minutes.

Source: NHIC, 2009.

 
CPT Codes / HCPCS Codes / ICD-9 Codes
HCPCS codes covered if selection criteria are met:
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
E0172 (for Traditional Plans) Seat lift mechanism placed over or on top of toilet, any type
E0621 Sling or seat, patient lift, canvas or nylon
E0625 (for Traditional Plans) Patient lift, bathroom or toilet, not otherwise classified
E0627 Seat lift mechanism incorporated into a combination lift-chair mechanism [except electric]
E0629 Separate seat lift mechanism for use with patient owned furniture - non-electric
E0630 Patient lift; hydraulic, with seat or sling
E0637 Combination sit to stand frame/table system, any size including pediatric, with seat lift feature, with or without wheels
E0638 Standing frame/table system, one position (e.g., upright, supine or prone stander), any size including pediatric, with or without wheels
E0641 Standing frame/table system, multi-position (e.g., three-way stander), any size including pediatric, with or without wheels
E0642 Standing frame/table system, mobile (dynamic stander), any size including pediatric
E1035 Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs
E1036 Multi-positional patient transfer system, extra-wide, with integrated seat, operated by care giver, patient weight capacity greater than 300 lbs
K0739 Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes
HCPCS codes not covered for indications listed in the CPB:
E0170 (for HMO-based plans) Commode chair with integrated seat lift mechanism, electric, any type
E0171 (for HMO-based plans) Commode chair with integrated seat lift mechanism, non-electric, any type
E0172 (for HMO-based plans) Seat lift mechanism placed over or on top of toilet, any type
E0625 (for HMO-based plans) Patient lift, bathroom or toilet, not otherwise classified
E0628 Separate seat lift mechanism for use with patient owned furniture - electric
E0635 Patient lift; electric, with seat or sling
E0636 Multipositional patient support system, with integrated lift, patient accessible controls
E0639 Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories
E0640 Patient lift, fixed system, includes all components/accessories
ICD-9 codes covered if selection criteria are met:
715.09, 715.15, 715.16, 715.18, 715.25, 715.26, 715.28, 715.35, 715.36, 715.38, 715.89, 715.95, 715.96, 715.98, 716.05, 716.06, 716.08, 716.09, 716.15, 716.16, 716.18, 716.19, 716.25, 716.26, 716.28, 716.29, 716.35, 716.36, 716.38, 716.39, 716.45, 716.46, Arthritis of hip and/or knee
358.00 - 358.9 Myoneural disorders


The above policy is based on the following references:
  1. U.S. Department of Health and Human Services, Center for Medicare & Medicaid Services (CMS). Medicare Coverage Issues Manual §§60-8 - 60-9. HCFA Pub. 6. Baltimore, MD: CMS; 2002.
  2. Edlich RF, Heather CL, Galumbeck MH. Revolutionary advances in adaptive seating systems for the elderly and persons with disabilities that assist sit-to-stand transfers. J Long Term Eff Med Implants. 2003;13(1):31-39.
  3. NHIC, Corp. Seat lift mechanisms. Medicare Local Contractor Determination (LCD) No. L11533. Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Jurisdiction A.  Hingham, MA: NHIC; revised February 4, 2011.
  4. NHIC Corp. Seat lift mechanisms. Medicare Local Coverage Article No. A19828. Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Jurisdication A. Hingham, MA: NHIC; revised September 1, 2009.
  5. NHIC, Corp. Patient lifts. Medicare Local Contractor Determination (LCD) No. L5064. Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Jurisdiction A. Hingham, MA: NHIC; revised February 4, 2011.
  6. NHIC, Corp. Patient lifts. Medicare Local Coverage Article No. A23657. Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Jurisdiction A. Hingham, MA: NHIC; revised January 1, 2010. 
  7. Alamgir H, Li OW, Yu S, et al. Evaluation of ceiling lifts: Transfer time, patient comfort and staff perceptions. Injury. 2009;40(9):987-992.
  8. Alamgir H, Li OW, Gorman E, et al. Evaluation of ceiling lifts in health care settings: Patient outcome and perceptions. AAOHN J. 2009;57(9):374-380.
  9. National Heritage Insurance Company (NHIC). Repair labor billing and payment policy. Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Jurisdiction A. Chico, CA: NHIC; February 26, 2009.


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Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
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