Notification



Notification Issue Date:



Medical Policy Bulletin


Title:Standing Frames

Policy #:05.00.71c

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


The Company makes decisions on coverage based on Policy Bulletins, benefit plan documents, and the member’s medical history and condition. 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.

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.



Policy

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

MEDICALLY NECESSARY

A non-powered, single-position standing frame (Healthcare Common Procedure Coding System [HCPCS] code E0638), a non-powered multi-positional standing frame (HCPCS code E0641), or a non-powered dynamic standing frame (HCPCS code E0642) is considered medically necessary and, therefore, covered when it is ordered following an appropriate rehabilitation evaluation, and all of the following indications are met:
  • The individual has a neuromuscular condition with an impaired ability to stand but, once standing, can maintain the standing position because of residual strength in the hips, legs, and lower body.
  • The individual requires the use of a wheelchair as a means of mobility.
  • The standing frame is appropriate for the individual's disability and size.
  • The standing frame is intended for use in the home.
  • The individual has a caregiver who is available, willing, and able to provide assistance with the standing frame.

In addition to the above criteria, a non-powered multi-positional standing frame system (HCPCS code E0641) is considered medically necessary and, therefore, covered when an individual has a medical condition that requires frequent changes in positioning.

In addition to the above criteria, a non-powered mobile (dynamic) standing frame system (HCPCS code E0642) is considered medically necessary and, therefore, covered when an individual has the upper arm strength to self-propel the device.

NOT MEDICALLY NECESSARY

All other uses for non-powered standing frames are considered not medically necessary and, therefore, not covered because the available published peer-reviewed literature does not support their use in the treatment of illness or injury.

BENEFIT CONTRACT EXCLUSION

A standing frame (E0637) with a motorized or powered feature is not covered by the Company because it is a benefit contract exclusion. Therefore, it is not eligible for reimbursement consideration.
  • Equipment with features of a medical nature that are not required for the individual’s condition. The therapeutic benefits of the item cannot be clearly disproportionate to its cost if there exists a medically necessary and realistically feasible alternative item that serves essentially the same purpose.

NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT

Accessories outside of the basic non-powered standing frame are not eligible for separate reimbursement.

REQUIRED DOCUMENTATION

The Company may conduct reviews and audits of services to our members regardless of the participation status of the provider. Medical record documentation must be maintained on file to reflect the medical necessity of the care and services provided. These medical records may include but are not limited to: records from the professional provider’s office, hospital, nursing home, home health agencies, therapies, and test reports. A specialty evaluation must be performed by a licensed/certified medical professional such as a physical or occupational therapist (PT/OT). A professional provider experienced with standing technology and rehabilitation of neuromuscular conditions may also perform specialty evaluations. This policy is consistent with Medicare's documentation requirements, including the following required documentation:

PRESCRIPTION (ORDER) REQUIREMENTS
Before submitting a claim to the Company, the supplier must have on file a timely, appropriate, and complete order for each item billed that is signed and dated by the professional provider who is treating the member. Requesting a provider to sign a retrospective order at the time of an audit or after an audit for submission as an original order, reorder, or updated order will not satisfy the requirement to maintain a timely professional provider order on file.

PROOF OF DELIVERY
Medical record documentation must include a contemporaneously prepared delivery confirmation or member’s receipt of supplies and equipment. The medical record documentation must include a copy of delivery confirmation if delivered by a commercial carrier and a signed copy of delivery confirmation by member/caregiver if delivered by the DME supplier/provider. All documentation is to be prepared contemporaneous with delivery and be available to the Company upon request.

CONSUMABLE SUPPLIES
The durable medical equipment (DME) supplier must monitor the quantity of accessories and supplies an individual is actually using. Contacting the individual regarding replenishment of supplies should not be done earlier than approximately seven days prior to the delivery/shipping date. Dated documentation of this contact with the individual is required in the individual’s medical record. Delivery of the supplies should not be done earlier than approximately five days before the individual would exhaust their on-hand supply.

If required documentation is not available on file to support a claim at the time of an audit or record request, the durable medical equipment (DME) supplier may be required to reimburse the Company for overpayments.
Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, standing frames are covered under the medical benefits of the Company’s products when the medical necessity criteria listed in this medical policy are met.

However, services that are identified in this policy as not medically necessary or a benefit exclusion are not eligible for coverage or reimbursement by the Company.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

Some standers are regulated by the U.S. Food and Drug Administration (FDA) through the 510K marketing process. Other devices may be 510K exempt and do not require clearance for marketing from the FDA.
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, 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.

Per available literature, non-ambulatory, physically disabled individuals may benefit from the use of a standing frame system for a number of health reasons, such as increasing range of motion; maintaining bone density and muscle strength; increasing cardiovascular endurance; reducing swelling in the lower limbs; decreasing spasticity (muscle overactivity); preventing pressure ulcers; increasing the ability to effectively move air flow through the lungs with improvement in pulmonary function; and improving bowel and bladder function.

Standing frames can be divided into three types; passive (static) stander, mobile (dynamic) stander, and active stander. The best type for an individual depends on height, weight, medical condition, and functional needs. There are a variety of standing frame models available within each type, including motorized or powered and non-motorized. The type and model of a standing system that is best for an individual depends upon the extent of the disability and the size of the individual.

The therapeutic benefits of a powered or motorized option standing frame cannot be clearly disproportionate to its cost if there exists a medically appropriate and realistically feasible alternative item that serves essentially the same purpose.

NON-POWERED PASSIVE (STATIC STANDERS)

The passive (static) standers remain in place and cannot be self-propelled. There are many models of passive standers. Two examples are sit-to-stand and multi-positional standers.

Sit-to-stand standers (e.g., EasyStand StrapStandand EasyStand Evolv) are highly functional because they can be used in sitting and standing and can usually be positioned at any angle between sitting and standing. A sit-to-stand stander requires the individual to have head control and fairly good trunk control.

Multi-positional standers (e.g., EasyStand Bantam) can be reversed so the individual can be placed in a prone (on the belly) or supine (on the back) position, depending on the individual’s abilities. These standers can be more difficult to use because they are sometimes closer to the floor, and transferring the individual in the stander can require two people; however, there are benefits to the prone/supine stander. For example, if the individual has poor head control, supine positioning can be employed. Then, when the individual develops better head control, the same stander can be utilized in a prone position to develop stronger neck and trunk muscles.

NON-POWERED MOBILE (DYNAMIC) STANDERS

A mobile (dynamic) stander allows individuals with upper body strength to self-propel. There are various models of mobile standers (e.g., Standing Dani®, Rifton Mobile Standers™, EasyStand Evolv Mobile, Rabbit Mobile Standing Frame and EasyStand Bantam Mobile option). A sit-to-stand stander uses a series of pulleys and wheels that allow the individual to self-propel while in a standing position, with minimal effort. Some mobile standers have a power option, in which the wheels are driven by motors and the stander is controlled by a joystick similar to a power wheelchair. Mobile standers are best for individuals who have good head control and upper body strength. For example, individuals diagnosed with spinal cord injuries, spina bifida, and cerebral palsy can benefit from both the added mobility and the standing position that a mobile stander provides.

NON-POWERED ACTIVE STANDERS

The active standers create reciprocal movement of the arms and legs while standing. This is a newer option in standing frames (e.g., EasyStand® Glider™). These standers have a “glider” attachment that allows the person to use either the arms alone or a combination of arms and legs to operate the mechanism and “glide” in a reciprocal walking-type pattern. Like the mobile stander, the individual in the active stander needs good head control and upper body strength, unless there is a caregiver who is able to assist.

SUMMARY

There are various types and many models available within each category of stander. The standing frame that best benefits the individual should be based on the extent of the individual's disability, size, and home environment.
References

Alizadeh-Meghrazi M, Masani K, Popovic MR, Craven BC. Whole-body vibration during passive standing in individuals with spinal cord injury: effects of plate choice, Frequency, amplitude, and subject's posture on vibration propagation. PM R. 2012;4(12):963-75. Epub 2012 Oct 24.


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.
2009;21(3):282-8.

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].




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)

MEDICALLY NECESSARY


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



Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References


Policy History

05.00.71c
02/15/2018This policy was reviewed and reissued in accordance with the Company's Policy Confirmation Review track. The references were updated accordingly. The policy was updated to be consistent with current template wording and format. The adoptable source for this policy are the Food and Drug Administration (FDA) labeling, literature, text books, articles.

Effective 10/05/2017 this policy has been updated to the new policy template format.
Version Effective Date: 03/22/2017
Version Issued Date: 03/22/2017
Version Reissued Date: 02/15/2018

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