Clinical UM Guideline


Subject:Seat Lift Mechanisms
Guideline #:  CG-DME-25Current Effective Date:  01/14/2014
Status:ReviewedLast Review Date:  11/14/2013

Description

Seat lift mechanisms are assistive devices used to lift the body from a sitting position to a standing position. The seat lift mechanism is also capable of lowering the individual from a standing to a sitting position.

Note: Please see the following related documents for additional information:

Clinical Indications

Medically Necessary:

A seat lift mechanism is considered medically necessary when all the following criteria are met:

Note: Documentation that an individual has difficulty or is even incapable of getting up from a chair, particularly a low chair, is insufficient justification for a seat lift mechanism. Most individuals who are capable of ambulating can raise up out of an ordinary chair if the seat height is appropriate and the chair has arms. 

Not Medically Necessary: 

A seat lift that operates by spring release mechanism with a sudden, catapult-like motion and jolts the individual from a seated to a standing position is considered not medically necessary.

A seat lift mechanism is considered not medically necessary when the criteria listed above are not met.

Coding

The following codes for treatments and procedures applicable to this document are included below for informational purposes.  Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy.  Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

HCPCS 
E0170Commode chair with integrated seat lift mechanism, electric, any type
E0171Commode chair with integrated seat lift mechanism, non-electric, any type
E0172Seat lift mechanism placed over or on top of toilet, any type
E0627Seat lift mechanism incorporated into a combination lift-chair mechanism
E0628Separate seat lift mechanism for use with patient owned furniture- electric
E0629Separate seat lift mechanism for use with patient owned furniture- non-electric
  
ICD-9 Diagnosis[For dates of service prior to 10/01/2014]
 All diagnoses
  
ICD-10 Diagnosis[For dates of service on or after 10/01/2014]
 All diagnoses
   
Discussion/General Information

Individuals with impaired mobility often require physical assistance in lifting and transferring. Numerous medical conditions (such as, arthritis, muscular dystrophy, and neuromuscular diseases) can lead to limited mobility as a result of pain, joint stiffness or muscle weakness. Individuals are often not able to move from a sitting position to a standing position without the assistance of another person or a device. Devices such as seat lift mechanisms have been employed to ease transfers and prevent injuries to the individual, caregiver, or both (CMS, 2005). These devices are utilized in the individual's home or place or residence. In establishing medical necessity for the seat lift, CMS states the seat lift must be included in the physician's course of treatment, that it is likely to effect improvement or arrest or retard deterioration in the individual's condition, and that the severity of the condition is such that the alternative would be chair or bed confinement (CMS, 1989).

References

Peer Reviewed Publications:

  1. 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.

Government Agency, Medical Society, and Other Authoritative Publications:

  1. Centers for Medicare and Medicaid Services (CMS). National Coverage Determinations. Available at: http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx. Accessed on August 19, 2013.

 

History

Status

Date

Action

Reviewed11/14/2013Medical Policy & Technology Assessment Committee (MPTAC) review. Format change to Coding section. Updated Discussion and References sections.
Reviewed11/08/2012MPTAC review. Updated References and removed/deleted Index.
Reviewed11/17/2011MPTAC review. Updated Coding and References.
Reviewed11/18/2010MPTAC review. Updated References.
Reviewed11/19/2009MPTAC review. Removed Place of Service and Discharge Plans. Updated Discussion, Coding and References.
Revised11/20/2008MPTAC review. Added a not medically necessary indication: A seat lift mechanism is considered not medically necessary when the criteria listed above are not met. Discussion and References updated.
Reviewed11/29/2007MPTAC review. References updated.
Reviewed12/07/2006MPTAC review. References updated.
New12/01/2005MPTAC initial document development.
Pre-Merger Organizations

Last Review Date

Document NumberTitle
Anthem, Inc.

 

None 
Anthem CT

 

DMESeat Lift Mechanisms
Anthem West (CO/NV)

10/29/2004

DME.209Seat Lift Mechanisms
WellPoint Health Networks, Inc.

 

None