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 Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
Chin M. Consider the alternatives: Alternative positioning can help improve a child’s function at home and school. TeamRehab Report.1994:18-20. Available at:http://www.wheelchairnet.org/WCN_ProdServ/Docs/TeamRehab/RR_94/9405art2.PDF. Accessed January 2, 2018.
Dunn RB, Walter JS, Lucero Y, et al. Follow-up assessment of standing mobility device users. Assist Technol. 1998;10:84-93.
Eng JJ, Levins SM, Townson AF, et al. Use of prolonged standing for individuals with spinal cord injuries. Phys Ther. 2001;81(8):1392-9 [abstr].
Gibson, SK, Sprod, JA, Maher, CA. The use of standing frames for contracture management for nonmobile children with cerebral palsy. Int J Rehabil Res. 2009;32(4):316-23.
Goktepe AS, Tugcu I, Yilmaz B, et al. Does standing protect bone density in patients with chronic spinal cord injury? J Spinal Cord Med. 2008;31(2):197-201.
Herman D, May R, Voge, L, et al. Quantifying weight-bearing by children with cerebral palsy while in passive standers. Pediatr Phys Ther. 2007;19(4):283-287.
Holland D, Holland T. Taking a stand. Rehab Manag.2006;19(2):44-9.
Lutz J, Chen F, Kasper C. Hypokinesia-induced negative net calcium balance reverse by weight bearing exercise. Aviation Space Environ Med. 1987;58:308-14.
Kecskemethy HH, Herman D, May R, et al. Quantifying weight bearing while in passive standers and a comparison of standers. Dev Med Child Neurol. 2008;50(7):520-3.
Taylor K. Factors affecting prescription and implementation of standing-frame programs by school-based physical therapists for children with impaired mobility. Pediatr Phys Ther.
Thompson CR, Figoni SF, Devocelle HA, et al. Effect of dynamic weight bearing on lower extremity bone mineral density in children with neuromuscular impairment. Clinical Kinesiology. 2000;54:13-18.
U.S. Food and Drug Administration 510(k) Premarket Notification Database. EasyStand Evolv™. No. K062402. Rockville, MD: FDA. September 21, 2006. Available at: http://www.accessdata.fda.gov/scripts/cdrh/devicesatfda/index.cfm?db=pmn&id=K062402. Accessed January 2, 2018.
U.S. Food and Drug Administration 510(k) Premarket Notification Database. Rabbit Mobile Standing Frame™. No. K030882. Rockville, MD: FDA. April 4, 2003. Available at: http://www.accessdata.fda.gov/scripts/cdrh/devicesatfda/index.cfm?db=pmn&id=K030882. Accessed January 2, 2018.
Walter JS, Sola PG, Sacks J, et al. Indications for a home standing program for individuals with spinal cord injury. J Spinal Cord Med. 1999;22(3):152-8 [abstr].
THE FOLLOWING CODES ARE USED TO REPRESENT A NON-POWERED STANDING SYSTEM:
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
BENEFIT CONTRACT EXCLUSION
The following code is used to represent a powered standing system:
E0637 Combination sit to stand frame/table system, any size including pediatric, with seat lift feature, with or without wheels
Policy: 05.00.44k:Repair and Replacement of Durable Medical Equipment (DME)