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.

  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 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.

    2. 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 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, 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.

    3. 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.

    4. Multi-Positional Transfer System

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

    5. Repairs

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

    6. 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. Related Policies

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:
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
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
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

ICD-10 codes covered if selection criteria are met:
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
G70.00 - G70.9, G73.1 - G73.7 Myoneural disorders

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.

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

The above policy is based on the following references:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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 October 31, 2014.
  6. 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 October 31, 2014.
  7. NHIC, Corp. Patient lifts. Medicare Local Coverage Article No. A23657. Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Jurisdiction A. Hingham, MA: NHIC; revised October 31, 2014. 
  8. 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 October 31, 2014.
  9. Thomas DR, Thomas YL. Interventions to reduce injuries when transferring patients: A critical appraisal of reviews and a realist synthesis. Int J Nurs Stud. 2014;51(10):1381-1394.
  10. 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.