E0627 — Seat lift mechanism, electric, any type
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted.
- For DMEPOS base items that require a Written Order Prior to Delivery (WOPD), the supplier must have received a signed SWO/WOPD prior to delivery of the item.
- WOPD for base items requiring it must list the base item and may list separately billed associated options, accessories, and supplies prior to delivery.
- Practitioner's medical record must document that appropriate therapeutic modalities (e.g., medication, physical therapy) were tried and failed to enable transfer from a chair to standing.
Key Coverage Criteria
- Beneficiary has severe arthritis of the hip or knee, or has a severe neuromuscular disease.
- Seat lift mechanism is part of the treating practitioner's course of treatment and is prescribed to effect improvement or to arrest/retard deterioration.
- Beneficiary is completely incapable of standing up from a regular armchair or any chair in their home (simple difficulty or inability with low chairs alone is insufficient).
- Once standing, the beneficiary must have the ability to ambulate.
- Covered seat lift mechanisms must operate smoothly, be controllable by the beneficiary, and effectively assist standing up and sitting down without other assistance.
- Practitioner ordering the seat lift must be the treating or consulting practitioner for the disease/condition that necessitates the device.
4 Active Policies
L33801 — Seat Lift Mechanisms
J19
AETNA-CPB-0429 — Bathroom and Toilet Equipment and Supplies
ANTHEM-CG-DME-25 — CG-DME-25 Seat Lift Mechanisms
REGENCE-DME23 — Patient Lifts and Seat Lifts
Related Codes
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