Notification



Notification Issue Date:



Medicare Advantage Policy

Title:Standing Frames
Policy #:MA05.055

This policy is applicable to the Company’s Medicare Advantage products only. Policies that are applicable to the Company’s commercial products are accessible via a separate commercial policy database.


The Company makes decisions on coverage based on the Centers for Medicare and Medicaid Services (CMS) regulations and guidance, benefit plan documents and contracts, and the member’s medical history and condition. If CMS does not have a position addressing a service, the Company makes decisions based on Company Policy Bulletins. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable. Although the Medicare Advantage Policy Bulletin is consistent with Medicare’s regulations and guidance, the Company’s payment methodology may differ from Medicare.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.


This Policy Bulletin document describes the status of CMS coverage, medical terminology, and/or benefit plan documents and contracts at the time the document was developed. This Policy Bulletin will be reviewed regularly and be updated as Medicare changes their regulations and guidance, scientific and medical literature becomes available, and/or the benefit plan documents and/or contracts are changed.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's Evidence of Coverage.

The Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition.


A standing frame is not covered by the Company because it is an item not covered by Medicare. Therefore, it is not eligible for reimbursement consideration.
Policy Guidelines

This policy is consistent with Medicare’s coverage determination.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, a standing frame is not eligible for payment under the medical benefits of the Company’s Medicare Advantage products because this item is considered not covered.

Description

A standing frame is known by many terms, such as a stand, a stander, standing technology, a standing aid, a standing device, a stand alone, standing table or a standing box. It is an assistive device typically used by an individual who requires a wheelchair for mobility. A standing frame provides alternative positioning from sitting in a wheelchair, and also supports the individual in an upright standing position.
References

Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD) 280.1 for DME Reference List. [CMS Web site]. Effective 5/5/2005. Available at:
https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=190&ncdver=2&NCDSect=280.1&bc=BEAAAAAAAQAAAA%3d%3d&. Accessed January 17, 2018.

Noridian Healthcare Solutions. Noncovered items. [NHIC Web site]. October 2017. Available at:https://med.noridianmedicare.com/web/jadme/article-detail/-/view/2230703/noncovered-items Accessed January 17, 2018.


Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

N/A


HCPCS Level II Code Number(s)



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


Revenue Code Number(s)

N/A

Coding and Billing Requirements






Policy History

MA05.055
06/19/2019This policy has been reissued in accordance with the Company's annual review process.
02/15/2018This policy has been reviewed and reissued to communicate the Company’s continuing position on Standing Frames.
03/15/2017This policy has been reviewed and reissued to communicate the Company’s continuing position on Standing Frames
03/16/2016This version of the policy will become effective on 03/16/2016.
This policy has been reviewed and reissued to communicate the Company’s continuing position on Standing Frames
01/21/2015The policy has been reviewed and reissued to communicate the Company’s continuing position on Standing Frames.
01/01/2015This is a new policy.






Version Effective Date: 01/01/2015
Version Issued Date: 01/01/2015
Version Reissued Date: 06/19/2019