Medicare Advantage

Medical Policy

Title:

Patient Lifts

Policy #:

MA05.031c

Policy

This policy uses coverage criteria developed solely based on applicable Medicare statutes, regulations, NCDs, LCDs, CMS manuals and other applicable Medicare coverage documents

COVERED

The following patient lifts are considered medically necessary and, therefore, covered when the individual's medical condition is such that: 1) without the use of a patient lift the individual would be bed confined; and 2) transferring of the individual between a bed and a chair, wheelchair, or commode is required:

Patient lift with hydraulic mechanism
Patient lift, electric, with seat or sling
Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories
Patient lift, fixed system, includes all components/accessories

The following multipositional patient support systems are considered medically necessary and, therefore, covered when the above criteria are met and the individual requires supine positioning for transfers:

Multipositional patient support system, with integrated lift, patient accessible controls
Multipositional patient transfer system, with integrated seat, operated by caregiver, patient weight capacity up to and including 300 pounds
Multipositional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 pounds

The initial 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

A patient lift (bathroom or toilet) is not covered by the Company because it is an item not covered by Medicare. Therefore, it is not eligible for reimbursement consideration.

Home modifications for any structural changes or remodeling necessitated by the installation of a lift system are not covered by the Company because they are not covered by Medicare. Therefore, they are not eligible for separate reimbursement consideration.

COLUMN I/COLUMN II REIMBURSEMENT EDITS

The reimbursement for the item(s) represented by the code(s) in column II are included in the reimbursement for the item represented by the code in column I.

Column I	Column II
E0625	E0621
E0630	E0621
E0635	E0621
E0636	E0621
E0639	E0621
E0640	E0621

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 durable medical equipment (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 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 7 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 5 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 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 (E0625, E0630, E0635, E0636, E0639,E0640) 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

This policy is consistent with Medicare's coverage determination. The Company's payment methodology may differ from Medicare.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, patient lifts are categorized as durable medical equipment (DME) and are covered under the medical benefits of the Company's Medicare Advantage products when the medical necessity criteria listed in this medical policy have been met.

However, patient lifts (bathroom or toilet) have been identified in this policy as not primarily medical in nature and, therefore, not eligible for coverage or reimbursement by the Company.

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 patient. 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.

Multipositional 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 multiposition 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). 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 January 26, 2026.

Centers for Medicare & 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 January 26, 2026.

Centers for Medicare & Medicaid Services (CMS). Medicare Claims Processing Manual. Chapter 20: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. [CMS Web site]. 03/28/2024. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c20.pdf. Accessed January 26, 2026.

Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD) 280.1: Durable Medical Equipment Reference List. [CMS Web site]. 10/22/2025. Available at: https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=190&ncdver=4&bc=AAAAIAAAAAAA&=. Accessed January 26, 2026.

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 January 26, 2026.

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/view/article.aspx?articleid=52516&ver=26&bc=0. Accessed January 26, 2026.

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 January 26, 2026.

Noridian Healthcare Solutions, LLC. Noridian's Noncovered Items List. Revised 11/24/2024. Available at: https://med.noridianmedicare.com/web/jddme/topics/noncovered-items. Accessed January 26, 2026.

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 January 26, 2026.

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)

E0635 Patient lift, electric, with seat or sling

E0636

Multipositional 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

NOT COVERED

E0625 Patient lift, bathroom or toilet, not otherwise classified

Revenue Code Number(s)

N/A

MPMiscCodesNarrativesPub

Coding and 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).

A Sling or seat, patient lift, canvas or nylon (E0621) is included in the reimbursement of the following patient lifts:

E0625 Patient lift, bathroom or toilet, not otherwise classified

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

E0635 Patient lift, electric, with seat or sling

E0636 Multipositional 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

Cross Reference

Policy History

Revisions From MA05.031c:

04/01/2026	The policy has been reviewed and reissued to communicate the Company’s continuing position on patient lifts.
04/02/2025	This policy has been reviewed in accordance with the Company's annual review process.
05/01/2024	This policy has been reviewed in accordance with the Company's annual review process.
01/01/2024	Effective 01/01/2024 this policy applies to New Jersey Medicare Advantage (MA) lines of business.
05/22/2023	This version of the policy will become effective 05/22/2023. The Face-to-Face requirements have been removed and no longer apply to codes: E0630 Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) E0635 Patient lift, electric, with seat or sling E0636 Multipositional 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

Revisions From MA05.031b:

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 for Healthcare Common Procedure Coding System (HCPCS) codes E0630, E0635, E0639, and E0640. This change was made consistent with Centers for Medicare & Medicaid Services (CMS) guidance.

Noncoverage of home modifications was added to the policy in accordance with Medicare.

Revisions From MA05.031a:

07/31/2019	The policy has been reviewed and reissued to communicate the Company's continuing position on Patient Lifts.
04/25/2018	The policy has been reviewed and reissued to communicate the Company's continuing position on Patient Lifts.
08/30/2017	The policy has been reviewed and reissued to communicate the Company's continuing position on Patient Lifts.
06/03/2016	This policy will become effective 06/03/2016. Billing requirements for HCPCS code E0621 was added to the policy section.

Revisions From MA05.031:

04/15/2015	This policy has been reviewed and reissued to communicate the Company's continuing coverage of patient lifts.
01/01/2015	This is a new policy.

Version Effective Date:

1/1/2024

Version Issued Date: