Seat Lifts and Patient Lifts

Number: 0459

Table Of Contents

Policy
Applicable CPT / HCPCS / ICD-10 Codes
Background
References

---

Policy

Scope of Policy

This Clinical Policy Bulletin addresses seat lifts and patient lifts, including stand-assist lifts, multi-positional transfer systems, and bariatric patient lifts and transfer equipment.

1. Medical Necessity

   Aetna considers the following seat lifts and patient lifts medically necessary:

   1. Seat Lifts

      Seat lift mechanisms as 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, investigational, or unproven 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, investigational, or unproven 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.

   2. Canvas or Nylon Sling or Seat

      A canvas or nylon sling or seat for a hydraulic/mechanical lift 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.

   3. Stand-Assist Lifts

      Stand-assist lifts (e.g., Sara Lift, Sara Stedy, Molift Raiser) as durable medical equipment (DME) when all of the following criteria are met:

      1. Manual Stand-Assist Lifts:

         1. The member has sufficient leg strength to come to and maintain at least a partial standing position; and
         2. The member requires assistance with the pivot portion of transfers between surfaces (e.g., bed to wheelchair, wheelchair to commode); and
         3. The member has one or more of the following conditions:
            
            
            1. Weak upper extremities insufficient for independent transfer
            2. Chronic pain or joint deterioration from previous transfer methods
            3. Fatigue limiting safe independent transfers
            4. Difficulty with balance during standing transfers; and
         4. The member's caregiver(s) cannot safely provide manual assistance for pivot transfers without assistive equipment; and
         5. The member does not meet criteria for a full patient lift (i.e., does not require assistance of more than one person and would not be bed-confined without a lift).

      2. Electric Stand-Assist Lifts:

         1. The member meets all criteria for manual stand-assist lifts listed above; and
         2. The member has one or more of the following additional conditions:
            
            
            1. Caregiver has documented physical limitations preventing safe operation of manual stand-assist lift
            2. Member weight exceeds safe operational capacity for manual stand-assist lift with available caregiver assistance
            3. Member has moderate trunk control deficits requiring powered assistance for safe transfer; and
         3. The member is able to tolerate weight-bearing through the legs; and
         4. The member exhibits sufficient trunk control to be safely transferred in a semi-standing position; and
         5. The member is not post-operative from thoracic or lumbar spinal surgery (contraindication due to spinal distraction forces).

      Notes:

      • Stand-assist lifts are considered experimental, investigational, or unproven for all other indications because of insufficient evidence in the peer-reviewed literature.
      • Coverage includes appropriate slings (thoracic support slings for electric models, standing slings for manual models) when provided with the initial lift or as replacement equipment.

   4. Patient Lifts

      Patient lifts (e.g., electric, Hoyer, hydraulic) as 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, investigational, or unproven 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, the Trans-Aid Lift, and the Sara (sit up to stand) 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.

   5. Bariatric Patient Lifts and Transfer Equipment

      Bariatric patient lifts and transfer equipment as DME when the member meets standard criteria for patient lifts or transfer devices and the member's weight exceeds the capacity of standard equipment:

      1. Bariatric Patient Lifts (Floor-Based):

         Medical necessity criteria:

         1. The member meets all criteria for standard patient lifts (transfer between bed and chair/wheelchair/commode requires assistance of more than one person, and without the lift the member would be bed-confined); and
         2. The member's weight exceeds 400 pounds (standard lift capacity); and
         3. The prescribed bariatric lift has a weight capacity of at least 150% of the member's current weight or manufacturer's rated capacity that safely accommodates the member, whichever is greater.

         Equipment specifications for bariatric lifts:

         1. Standard bariatric floor lifts: Weight capacity 600-1000 pounds
         2. Must include emergency stop mechanism and manual emergency release lowering capability
         3. Must include appropriately sized bariatric sling (split-leg, full body/hammock, or standing sling as clinically appropriate)

      2. Bariatric Transfer Boards:

         Medical necessity criteria:

         1. The member meets criteria for standard transfer boards (low tetraplegia or paraplegia, or insufficient upper body strength to fully clear buttocks between surfaces); and
         2. The member's weight exceeds 400 pounds (standard transfer board capacity).

         Equipment specifications:

         1. Bariatric transfer boards must have weight capacity of at least 150% of member's current weight
         2. Boards must be thicker construction to accommodate increased load
         3. Width must be appropriate for member's body habitus (typically wider than standard 8-12 inches)

      3. Bariatric Stand-Assist Lifts:

         Medical necessity criteria:

         1. The member meets all criteria for standard stand-assist lifts; and
         2. The member's weight exceeds the capacity of standard stand-assist equipment (typically 400-450 pounds); and
         3. The prescribed bariatric stand-assist lift has appropriate weight capacity for safe operation.

      4. Replacement Slings and Accessories:

         Bariatric-sized replacement slings are covered when:

         1. Ordered as replacement for original equipment that has worn out or been damaged
         2. Appropriately sized for member's current weight and body habitus
         3. Compatible with member's existing lift system

      Notes:

      • Weight capacity requirements are based on manufacturer specifications and must be documented.
      • All bariatric equipment must be appropriate for the specific transfer locations in the member's home (doorway width, floor clearance).
      • Bariatric equipment is considered experimental, investigational, or unproven when member does not meet underlying criteria for standard equipment of the same type.

   6. Multi-Positional Transfer System

      Multi-positional transfer systems as DME when all of the following criteria are met:

      1. The member meets criteria for a standard manual transfer device (transfer board); and
      2. The member has a documented medical condition requiring supine transfer, including one or more of the following:
         
         
         1. Acute spinal injury requiring spinal motion restriction during transfers
         2. Post-operative spinal surgery with physician-documented restrictions on sitting transfers
         3. Severe orthostatic hypotension preventing safe seated transfers
         4. Unstable fractures requiring horizontal positioning during transfers
         5. Severe trunk instability with inability to maintain seated position safely; and
      3. Standard transfer boards or seated transfer methods are contraindicated or unsafe for the member's condition; and
      4. The member requires transfers between surfaces (e.g., bed to stretcher, bed to examination table) as part of routine care.

      Equipment Specifications:

      Multi-positional transfer systems must include:

      1. Ability to maintain patient in supine position throughout transfer
      2. Friction-reducing or rolling surface to minimize shear forces
      3. Weight capacity appropriate to member's weight
      4. Compatibility with member's bed and destination transfer surfaces.

      Notes:

      • Scoop stretchers, vacuum mattresses, and similar devices used solely for emergency medical transport are not covered under this provision.
      • Multi-positional transfer systems are considered experimental, investigational, or unproven for all other indications because of insufficient evidence in the peer-reviewed literature.

   7. Repairs

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

   8. Non-Covered Lifts

      1. Aetna does not cover the following types of lifts because:

         1. The below do not meet Aetna's contractual definition of covered DME:

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

         2. The below are considered home modifications:

            1. Ceiling lifts (patient lifts mounted on tracks that are attached to the ceiling),
            2. Platform lifts, stair lifts/stairway chairs, elevators, and stairway elevators (e.g., Stair Glide chair).
      2. Aetna does not cover an electric powered recliner and elevating seat because it is not considered primarily medical in nature.
      3. Aetna considers motorized electric lifts (e.g., Saralift) not medically necessary convenience items.

2. Plan Limitations and Exclusions

   Consistent with DME MAC policy:

   Treating practitioner means physician (MD or DO) or physician assistant, nurse practitioner, or clinical nurse specialist. A prosthetist, orthotist, orthotic fitter, pedorthotist, physical therapist, or occupational therapist is not considered a treating practitioner.

   A new prescription from the treating practitioner is required each time a new device or repair is requisitioned.

   There must be sufficient medical information included in the medical record to demonstrate that all applicable coverage criteria are met.

   Consistent with DME MAC policy:

   Supplier prepared statements and physician attestations by themselves do not provide sufficient documentation of medical necessity, even if signed by the ordering physician.

   "Neither a practitioner’s order, nor a supplier-prepared statement, nor a practitioner’s attestation by itself provides sufficient documentation of medical necessity, even though it is signed by the treating practitioner or supplier. There must be information in the member’s medical record that supports the medical necessity for the item and substantiates the information on a supplier-prepared statement or treating practitioner’s attestation (if applicable)."

   "Forms are subject to corroboration with information in the medical record."

   Records from suppliers or healthcare professionals with a financial interest in the claim outcome are not considered sufficient by themselves for the purpose of determining that an item is reasonable and necessary. 

   Consistent with DME MAC policy:

   A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted. If the supplier bills for an item addressed in this policy without first receiving a completed SWO, the claim shall be denied as not medically necessary.

   The SWO must contain all the following elements:

   • Member's name or identification number
   • Order date
   • General description of the item
     
     
     • The description can be either a HCPCS code, a HCPCS code narrative, or a brand name/model number
     • In addition to the description of the base item, the SWO must include all concurrently ordered options, accessories or additional features that are separately billed or require an upgraded code (List each separately).
     • For supplies -- In addition to the description of the base item, the order/prescription must include all concurrently ordered supplies that are separately billed (List each separately)
       
       
   • Each item or service requested must individually list the HCPCS code (Procedure code) and quantity to be dispensed
   • Treating practitioner name and national provider identifier (NPI)
   • Treating practitioner's signature.

3. Related Policies

   • CPB 0271 - Wheelchairs and Power Operated Vehicles (Scooters)
   • CPB 0429 - Bathroom and Toilet Equipment and Supplies
   • CPB 0430 - Pressure Reducing Support Surfaces
   • CPB 0434 - Therapeutic Chairs
   • CPB 0481 - Tables and Boards
   • CPB 0543 - Hospital Beds and Accessories
   • CPB 0623 - Safety Items

---

Table:

CPT Codes / HCPCS Codes / ICD-10 Codes

Code	Code Description
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
E0629	Separate seat lift mechanism for use with patient owned furniture - non-electric
E0630	Patient lift; hydraulic, with seat or sling
E0635	Patient lift; electric, 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
E0705	Transfer device, any type, each
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
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
HCPCS codes related for indications listed in the CPB:
L0120	Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar)
L0140	Cervical, semi-rigid, adjustable (plastic collar)
L0172	Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf
L0174	Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf
L0180	Cervical, multiple post collar, occipital/mandibular supports, adjustable
ICD-10 codes covered if selection criteria are met:
G70.00 - G70.9, G73.1 - G73.7	Myoneural disorders
G82.20-G82.54	Paraplegia (paraparesis) and quadriplegia (quadriparesis)
G89.21 - G89.29	Chronic pain
G89.4	Chronic pain syndrome
I95.1	Orthostatic hypotension
M12.151 - M12.169, M12.551 - M12.569 M12.851 - M12.869, M13.851 - M13.869 M15.0 - M15.9, M16.0 - M17.9	Arthritis of hip and/or knee
M62.81	Muscle weakness (generalized)
R53.1	Weakness
R53.81-R53.83	Malaise and fatigue
S12.02XA – S12.02XS	Unstable burst fracture of first cervical vertebra, initial encounter for closed fracture
S12.100A – S12.191S	Fracture of second cervical vertebra
S12.200A - S12.291S	Fracture of third cervical vertebra
S12.300A - S12.391S	Fracture of fourth cervical vertebra
S12.400A - S12.491S	Fracture of fifth cervical vertebra
S12.500A - S12.591S	Fracture of sixth cervical vertebra
S12.600A - S12.691S	Fracture of seventh cervical vertebra
S14.0XXA - S14.9XXS	Injury of nerves and spinal cord at neck level
S22.000A - S22.089S	Unstable burst fracture of first thoracic vertebra, initial encounter for closed fracture
S24.0XXA - S24.9XXS	Injury of nerves and spinal cord at thorax level
S24.101A - S24.109S	Unspecified injury of thoracic spinal cord
S24.111A - S24.119S	Complete lesion of thoracic spinal cord
S32.000A - S32.059S	Unstable burst fracture of first lumbar vertebra
S34.01XA - S34.9XXS	Injury of lumbar and sacral spinal cord and nerves at abdomen, lower back and pelvis level
Z48.811	Encounter for surgical aftercare following surgery on the nervous system
Z47.82	Encounter for orthopedic aftercare following scoliosis surgery

---

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 preclude the use of a standard transfer device (i.e., hydraulic/mechanical lift).

A multi-positional patient transfer system, with integrated seat, operated by the 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 caster wheels that are not accessible by the member for mobility. It has no electric controls.

A multi-positional patient support system, with integrated lift and 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 for the lift function.

A patient lift, movable 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 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 a 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 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 a 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 or 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.

Table: Medically necessary repair units of service allowances

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, 2014.

---

References