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).

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.

Key: One unit of service = 15 minutes.

Source: NHIC, 2009.