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Medical Policy Bulletin

Patient Lifts
05.00.42i



Policy

COVERED

A patient lift with a hydraulic mechanism 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 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.

NOT COVERED

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
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. hydraulic lift).
  • Electric patient lifts
  • 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
  • Multi-positional patient support systems
Inclusion of a code in this policy does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

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.

STANDARD WRITTEN ORDER REQUIREMENTS
Before submitting a claim to the Company, the supplier must have on file a timely, appropriate, and complete standard written 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 standard written order at the time of an audit or after an audit for submission as an original standard written order, reorder, or updated standard written order will not satisfy the requirement to maintain a timely professional provider standard written order on file.

PROOF OF DELIVERY REQUIREMENTS
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 (WHEN APPLICABLE)
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.

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.

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 or Class II 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 individual. According to the US Food and Drug Administration (FDA), a hydraulic lift is considered as either a Class I ​or Class II 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 individual.

Multi-positional patient transfer systems are devices that can be positioned and adjusted such that the bed-bound individual​ 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 and Medicaid Services (CMS). Federal Register. Medicare Program; End-stage renal disease prospective payment system, payment for renal dialysis services furnished to individuals with acute kidney injury, end-stage renal disease quality incentive program, durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) fee schedule amounts, DMEPOS competitive bidding program (CBP) amendments, standard elements for a DMEPOS order, and master list of DMEPOS items potentially subject to a face-to-face encounter and written order prior to delivery and/or prior authorization requirements for calendar year (CY) 2022; Final Rule. [Federal Register Web site]. 01/01/2022. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/DMEPOS/Downloads/FINAL-RULE-MASTER-LIST-of-DMEPOS-Subject-to-Frequent-Unnecessary-Utilization-2018-03-30.pdf.  Accessed April 06, 2023.


Centers for Medicare and Medicaid Services (CMS). Federal Register. Medicare Program; Updates to Face-to-Face Encounter and Written Order Prior to Delivery List, 88 Fed Reg, 2546 (01/17/2023). Available at:   https://public-inspection.federalregister.gov/2023-00718.pdf. Accessed April 06, 2023.

 
Centers for Medicare & Medicaid Services (CMS). Medicare Claims Processing Manual. Chapter 20: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. [CMS Web site]. 06/11/202. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c20.pdf. Accessed April 06, 2023.

Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD) 280.1: Durable Medical Equipment Reference List. [CMS Web site]. 07/05/2005. Available at: https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=190&ncdver=2&bc=AAAAIAAAAAAA&. Accessed April 06, 2023.


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 April 06, 2023.

Company Benefit Contracts.


Noridian Healthcare Solutions, LLC. Local Coverage Article: Patient Lifts - Policy Article (A52516). Effective 01/01/2020. Available at: https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52516&ver=10&Cntrctr=389&name=&DocType=Active&DocStatus=Active&ContrVer=1&CntrctrSelected=389*1&s=9&LCntrctr=139*1&bc=AhAAAAMAAAAA&. Accessed April 06, 2023.

Noridian Healthcare Solutions, LLC. Local Coverage Determination (LCD) Patient Lifts (L33799). Effective 01/01/2020. Available at: https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33799&ContrId=389. Accessed April 06, 2023.

Noridian Healthcare Solutions, LLC. Noridian's Noncovered Items List. Revised 12/19/2019. Available at:
https://med.noridianmedicare.com/web/jadme/search-result/-/view/2230703/noncovered-items. Accessed April 06, 2023.


US Food and Drug Administration (FDA). Medical device classification product codes – Guidance for industry and food and drug administration staff. [FDA Web site]. 05/21/2015. Available at: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/medical-device-classification-product-codes-guidance-industry-and-food-and-drug-administration-staff. Accessed April 06, 2023.​


Coding

CPT Procedure Code Number(s)
N/A

ICD - 10 Procedure Code Number(s)
N/A

ICD - 10 Diagnosis Code Number(s)
N/A

HCPCS Level II Code Number(s)
COVERED

E0621 Sling or seat, patient lift, canvas or nylon

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

NOT 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

Policy History

Revisions From 05.00.42i:​
​05/01/2024
This policy has been reviewed in accordance with the Company's annual review process.
05/22/2023​

This version of the policy will become effective 05/22/2023.  ​

The Face-to-Face requirements no longer apply to code E0630 Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s)​


Revisions From 05.00.42h:
06/29/2022​
The policy has been reviewed and reissued to communicate the Company’s continuing position on Patient Lifts.​
06/02/2021
The policy has been reviewed and reissued to communicate the Company’s continuing position on Patient Lifts.​
​02/15/2021

This version of the policy will become effective 02/15/2021. This policy was updated to reflect a change in the Face-to-Face requirements. This change was made consistent with Centers for Medicare & Medicaid Services (CMS)​​ guidance.

Revisions From 05.00.42g:
07/31/2019The policy has been reviewed and reissued to communicate the Company's continuing position on Patient Lifts.
​04/25/2018

This 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.
05/22/2023
05/22/2023
05/01/2024
05.00.42
Medical Policy Bulletin
Commercial
No