Notification



Notification Issue Date:



Medical Policy Bulletin


Title:Patient Lifts

Policy #:05.00.42g

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.

COVERED PATIENT LIFTS

A patient lift with a hydraulic mechanism (E0630) is considered medically necessary and, therefore, covered when the following criteria are met:
  • The individual's medical condition is such that without the use of a patient lift the individual would be bed confined.
  • Transfer of the individual between a bed and a chair, wheelchair, or commode requires the assistance of more than one person.

The seat or sling (E0621) is included as part of an initial patient lift. Therefore, it is not eligible for separate reimbursement consideration by the Company unless it is ordered as a replacement accessory for a covered patient lift.

NONCOVERED PATIENT LIFTS

The following patient lift is a benefit contract exclusion and, therefore, not covered and not eligible for reimbursement consideration by the Company because it is considered a convenience item.
  • Patient lifts for the bathroom and/or toilet (E0625)

The following patient lifts are benefit contract exclusions and, therefore, not covered and not eligible for reimbursement consideration by the Company because these items are equipment with features of a medical nature that are not required for the individual’s condition. The therapeutic benefits of these items cannot be clearly disproportionate to their cost if there exists a medically necessary and realistically feasible alternative item that serves essentially the same purpose (e.g., HCPCS code E0630).
  • Electric patient lifts (E0635)
  • Portable ceiling lift systems for the home with a track that makes them moveable from room to room, and/or fixed lift systems for the home (E0639 and E0640)
  • Multi-positional patient support systems (E0636, E1035 and E1036)

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

FACE-TO-FACE REQUIREMENTS

As a condition for payment, a professional provider must have a face-to-face examination with the individual, for whom certain specified items are ordered, that meets all of the following requirements:
  • The treating professional provider must have an in-person examination with the individual within the six (6) months prior to the date of the written order prior to delivery.
  • This examination must document that the individual was evaluated and/or treated for a condition that supports the need for the item(s) of DME ordered.

A new face-to-face examination is required each time a new prescription for one of the specified items is ordered. A new prescription is required:
  • For all claims for purchases or initial rentals
  • When there is a change in the prescription for the accessory, supply, drug, etc.
  • If periodic prescription renewal is required per medical policy
  • When an item is replaced
  • When there is a change in the supplier
  • When required by state law

In this policy the specified items are:

E0636 MULTIPOSITIONAL PATIENT SUPPORT SYSTEM, WITH INTEGRATED LIFT, PATIENT ACCESSIBLE CONTROLS
E1035MULTI-POSITIONAL PATIENT TRANSFER SYSTEM, WITH INTEGRATED SEAT, OPERATED BY CARE GIVER, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 LBS
E1036 MULTI-POSITIONAL PATIENT TRANSFER SYSTEM, EXTRA-WIDE, WITH INTEGRATED SEAT, OPERATED BY CAREGIVER, PATIENT WEIGHT CAPACITY GREATER THAN 300 LBS

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. 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.

Documentation of a face to face encounter, between the treating professional provider and the individual meeting the above requirements, including an assessment of the individual’s clinical condition supporting the need for the prescribed DME item(s) must be provided to and kept on file by the DME supplier.

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.

BILLING REQUIREMENTS

To report the replacement of a seat or sling to a previously purchased patient lift that is eligible for coverage by the Company, providers must use HCPCS code E0621 (sling or seat, patient lift, canvas or nylon).

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

Hydraulic patient lifts are considered Class I medical devices with general controls and are exempt from premarket notification procedures.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, patient lifts are categorized as durable medical equipment (DME) and are covered under the medical benefits of most of the Company's products. Individual benefits must be verified as some benefit contracts exclude DME.

Description

A patient lift is a hydraulic or electrically powered device, either fixed or mobile, that is used to lift and transport an individual in the horizontal or other required position from one place to another (e.g., from a bed to a bath). Patient lifts are categorized as durable medical equipment (DME).

A hydraulic (Hoyer) lift is a patient lift with a standard lifting mechanism that is operated by the resistance offered or the pressure transmitted when a quantity of liquid (e.g., water, oil) is forced through a comparatively small orifice or tube. The device includes straps and a sling to support the patient. According to the US Food and Drug Administration (FDA), a hydraulic lift is considered a Class I medical device with general controls and is exempt from premarket notification procedures.

An electric lift is a patient lift with an enhanced lifting mechanism that is operated by electricity. The device includes straps and a sling to support the patient.

Multi-positional patient transfer systems are devices that can be positioned and adjusted such that the bed-bound patient can be transferred onto the device in the supine position. Once positioned on the device, the multi-position patient transfer system can be adjusted to a chair-like position with multiple degrees of recline and leg elevation.

Some patient lifts that are used in the home require modifications to a dwelling. Lifts requiring dwelling modifications include either of the following:
  • A portable ceiling lift system for the home with a track that makes it moveable from room to room
  • A fixed lift system that is permanently installed in the home

References


Centers for Medicare & Medicaid Services (CMS). Medicare Coverage Issues Manual. Durable medical equipment and prosthetic devices. Part 60-9: Durable medical equipment reference list. Patient lifts. [CMS Web site]. Available at: http://www.cms.hhs.gov/manuals/downloads/Pub06_PART_60.pdf. Accessed March 8, 2018.

Company Benefit Contracts.

Noridian Healthcare Solutions, LLC. Local Coverage Determination (LCD) Patient Lifts (L33799). Effective 01/01/2017. Available at: https://med.noridianmedicare.com/documents/2230703/7218263/Patient+Lifts+LCD+and+PA/a6ab3b12-6726-470c-9a11-cf1477850ccc. Accessed March 8, 2018.

Noridian Healthcare Solutions, LLC. Local Coverage Article: Patient Lifts - Policy Article (A52516).
Effective 01/01/2017. Available: https://med.noridianmedicare.com/documents/2230703/7218263/Patient+Lifts+LCD+and+PA/a6ab3b12-6726-470c-9a11-cf1477850ccc. Accessed March 8, 2018.

Noridian Healthcare Solutions, LLC. Noridian's Noncovered Items List. Revised Jan 29, 2018. Available at:
https://med.noridianmedicare.com/web/jadme/search-result/-/view/2230703/noncovered-items. Accessed March 8, 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)

COVERED


E0630 Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s)

E0621 Sling or seat, patient lift, canvas or nylon


NON-COVERED

E0625 Patient lift, bathroom or toilet, not otherwise classified

E0635 Patient lift, electric, with seat or sling

E0636 Multi-positional patient support system, with integrated lift, patient accessible controls

E0639 Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories

E0640 Patient lift, fixed system, includes all components/accessories

E1035 Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs

E1036 Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs


THE FOLLOWING CODE IS NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT WHEN REPORTED AS AN INITIAL SEAT OR SLING:

E0621 Sling or seat, patient lift, canvas or nylon



Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References


Policy History

REVISIONS FROM 05.00.42g
04/25/2018This policy has been reviewed and reissued to communicate the Company's continuing coverage of patient lifts.


Effective 10/05/2017 this policy has been updated to the new policy template format.

Version Effective Date: 06/03/2016
Version Issued Date: 07/02/2014
Version Reissued Date: 04/25/2018

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2017 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.