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Date Printed: October 23, 2017: 02:04 AM

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This medical policy (medical coverage guideline) is Copyright 2017, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association. The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

09-E0000-52

Original Effective Date: 11/15/04

Reviewed: 06/25/09

Revised: 01/01/17

Subject: Seat Lift Mechanisms

THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION.

           
Position Statement Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines
           
Other References Updates    
           

DESCRIPTION:

A seat lift is described as a mechanical seat in a chair that tilts to aid the patient into the standing position.

POSITION STATEMENT:

Seat lift mechanisms meet the definition of medical necessity when ALL of the following criteria are met:

Medically necessary seat lift mechanisms are those devices that operate smoothly, can be controlled by the individual, and effectively assist the individual in standing up and sitting down without other assistance.

NOTE: Seat lift mechanisms that operate by spring release action with a sudden, catapult-like motion that jolts the individual from a seated position to a standing position are not covered.

BILLING/CODING INFORMATION:

The following codes may be used to describe seat lift mechanisms:

HCPCS Coding

E0627

Seat lift mechanism, electric, any type

E0629

Seat lift mechanism, non-electric, any type

REIMBURSEMENT INFORMATION:

Reimbursement is limited to the seat lift mechanism, even if it is incorporated into a chair (i.e., E0627). Therefore, reimbursement for E0627 will be based on the allowance for the least costly alternative (i.e., E0628 or E0629).

PROGRAM EXCEPTIONS:

Federal Employee Program (FEP): Follow FEP guidelines.

State Account Organization (SAO): Follow SAO guidelines.

Medicare Advantage products:

The following National Coverage Determination (NCD) was reviewed on the last guideline reviewed date: Seat Lifts(280.4) located at cms.gov.

The following Durable Medical Equipment Regional Carrier (DMERC) Local Coverage Determination (LCD) was reviewed on the last guideline reviewed date: Mechanisms (L33801) located at cgsmedicare.com

DEFINITIONS:

No guideline specific definitions apply.

RELATED GUIDELINES:

Durable Medical Equipment (DME), 09-E0000-01

OTHER:

None applicable.

REFERENCES:

  1. Centers for Medicare and Medicaid Services (CMS) National Coverage Determination for Seat Lifts, Pub 100-3, Section 280.4 (05/01/89).
  2. Region C Medicare DMERC Local Coverage Determination for Mechanisms (L33801) (07/01/16).

COMMITTEE APPROVAL:

This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 06/25/09.

GUIDELINE UPDATE INFORMATION:

11/15/04

New Medical Coverage Guideline.

10/15/06

Scheduled review (consensus review); no change in coverage statement.

08/15/07

Review, coverage statements maintained, guideline reformatted, references updated.

07/15/09

Scheduled review; no change in position statement; references updated.

05/15/14

Revision; Program Exceptions section updated.

01/01/17

Annual CPT/HCPCS update. Revised E0627 & E0629; deleted E0628. Program Exception section and references updated.

Date Printed: October 23, 2017: 02:04 AM