E0635, Patient lift, electric with seat or sling
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 requiring a Written Order Prior to Delivery (WOPD), the supplier must have received a signed WOPD before delivery; the WOPD must list the base item and may list separately billed associated options, accessories, or supplies.
- Proof of delivery (POD) documentation must be maintained by the supplier and made available to the Medicare contractor upon request.
- Claims must be correctly coded per CMS HCPCS guidelines, LCDs, LCD-related Policy Articles, or DME MAC articles to be reimbursed.
Key Coverage Criteria
- Item must be eligible for a defined Medicare benefit category to be covered.
- Item must be reasonable and necessary for diagnosis or treatment of illness/injury or to improve functioning of a malformed body member (per SSA §1862(a)(1)(A)).
- A patient lift is covered when transfer between bed and a chair, wheelchair, or commode is required and, without the use of a lift, the beneficiary would be bed confined.
- HCPCS E0630, E0635, E0639, and E0640 are covered when the basic patient lift coverage criteria are met.
- Multi-positional patient transfer systems (HCPCS E0636, E1035, E1036) are covered only if the basic lift coverage criteria are met and the beneficiary requires supine positioning for transfers.
- HCPCS E0621 is covered as an accessory only when ordered as a replacement for a covered patient lift.
8 Active Policies
ANTHEM-CG-DME-23, CG-DME-23 Lifting Devices for Use in the Home
L33799, Patient Lifts
BCBSIL-DME101.034, Seat Lift Mechanisms and Patient Lifts
BCBSMT-DME101.034, Seat Lift Mechanisms and Patient Lifts
BCBSNM-DME101.034, Seat Lift Mechanisms and Patient Lifts
Related Codes
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