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 (e.g., electric, Hoyer, hydraulic) 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.

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/stairway chairs, elevators, and stairway elevators (e.g., Stair Glide chair).

Aetna does not cover an electric powered recliner and elevating seat because it is not considered primarily medical in nature. 

Canvas or Nylon Sling or Seat

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. Note: A nylon or canvas sling or seat for a patient lift is included in the allowance for a patient lift when provided at the same time.

Multi-Positional Transfer System

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.

Non-Powered Standing Device

- see CPB CPB 0481 - Tables and Boards.

Repairs

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

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 Medicare Administrative Contractor (DME MAC) 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).

A multi-positional patient transfer system, with integrated seat, operated by caregiver describes a device that can be positioned and adjusted such that the bed-bound member can be transferred onto the device in the supine position. Once positioned on the device, it can then be adjusted to a chair-like position with multiple degrees of recline and leg elevation. It has small, castor wheels that are not accessible by the member for mobility. It has no electric controls.

A multi-positional patient support system, with integrated lift, patient accessible controls describes a device that can be used to transfer the bed-bound member in either a sitting or supine position. It has electric controls of the lift function.

A patient lift, moveable from room to room with disassembly and reassembly, describes a device in which the lift mechanism is part of a floor-to-ceiling pole system that is not permanently attached to the floor and ceiling and which is used in a room other than the bathroom. The lift/transport mechanisms may be mechanical or electric. No separate payment is made for installation. All costs associated with installation are included in the payment for the device.When a device is only used in a bathroom, it is coded as patient lift, bathroom or toilet, not otherwise classified.

A patient lift, fixed system, describes a device in which the lift mechanism is attached to permanent ceiling tracks or a wall mounting system and which is used in a room other than the bathroom. The lift/transport mechanisms may be mechanical or electric. No separate payment is made for installation. All costs associated with installation are included in the payment for the device. When a device is only used in a bathroom, it is coded as patient lift, bathroom or toilet, not otherwise classified.

A toilet seat lift mechanism is a device with a seat that can be raised with or without a forward tilt while the beneficiary is seated, allowing the member to ambulate once he/she is in a more upright position. It may be manually operated or electric. It is attached to the toilet.

A patient lift for a toilet/tub, any type describes a device with which the member can be transferred from the toilet/tub to another seat (e.g., wheelchair). It is used for a member who is unable to ambulate. Devices may be attached to the toilet, ceiling, floor, or wall of the bathroom or may be freestanding. Some items may be placed in a tub for lifting the member in and out of the tub but may not necessarily be attached to the toilet, ceiling, floor, or wall of the bathroom.

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, 2014.

The above policy is based on the following references: