1. The seat lift mechanism must be ordered by the treating physician.

2. A seat lift mechanism is considered medically necessary when all of the following criteria are met:

• The member would be confined to a chair or bed without the device.
• The member cannot rise from a chair without assistance.
• The treating physician certifies the device is of therapeutic benefit to the member, by facilitating mobility or activity that would promote improvement, and arrest or retard deterioration in the patient's condition.

A. Coverage of seat lift mechanisms is limited to those types which operate smoothly, can be controlled by the member, and effectively assist a member in standing up and sitting down without other assistance.
B. Coverage is limited to the seat lift mechanism only, even if it is incorporated into a chair.
C. A type of lift which operates by spring release mechanism with a sudden, catapult-like motion and jolts the member from a seated to a standing position is excluded from coverage due to safety concerns.

FIDE-SNP Coverage:
For members enrolled in a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP): (1) to the extent the service is covered under the Medicare portion of the member’s benefit package, the above Medicare Coverage statement applies; and (2) to the extent the service is not covered under the Medicare portion of the member’s benefit package, the above Medicaid Coverage statement applies

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Horizon BCBSNJ Medical Policy Development Process:

This Horizon BCBSNJ Medical Policy (the “Medical Policy”) has been developed by Horizon BCBSNJ’s Medical Policy Committee (the “Committee”) consistent with generally accepted standards of medical practice, and reflects Horizon BCBSNJ’s view of the subject health care services, supplies or procedures, and in what circumstances they are deemed to be medically necessary or experimental/ investigational in nature. This Medical Policy also considers whether and to what degree the subject health care services, supplies or procedures are clinically appropriate, in terms of type, frequency, extent, site and duration and if they are considered effective for the illnesses, injuries or diseases discussed. Where relevant, this Medical Policy considers whether the subject health care services, supplies or procedures are being requested primarily for the convenience of the covered person or the health care provider. It may also consider whether the services, supplies or procedures are more costly than an alternative service or sequence of services, supplies or procedures that are at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the relevant illness, injury or disease. In reaching its conclusion regarding what it considers to be the generally accepted standards of medical practice, the Committee reviews and considers the following: all credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, physician and health care provider specialty society recommendations, the views of physicians and health care providers practicing in relevant clinical areas (including, but not limited to, the prevailing opinion within the appropriate specialty) and any other relevant factor as determined by applicable State and Federal laws and regulations.

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Index:
Seat Lift Mechanisms
Electric Seat Lift Chair
Seat Lift Chair, Electric

References:
1. ECRI. Lifts, patient transfer; slings, patient lift. In: Healthcare Product Comparison System, Hospital Edition, Plymouth Meeting, PA: ECRI, 1999.

2. Wickizer TM. Controlling outpatient medical equipment costs through utilization management. Med Care 1995 Apr;33(4):383-391.

3. Gear AJ, Suber F, Neal JG, et al. New assistive technology for passive standing. J Burn Care Rehabil 1999 Mar-Apr;20(2):164-169.

4. Millington PJ, Myklebust BM, Shambes GM. Biomechanical analysis of the sit-to-stand motion in elderly persons. Arch Phys Med Rehabil 1992 Jul;73(7):609-617.

5. Hughes MA, Schenkman ML. Chair rise strategy in the functionally impaired elderly. J Rehabil Res Dev 1996 Oct;33(4):409-412.

6. Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD) for : Seat Lift (280.4) Effective 5/1/1989. [Available at http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=221&ncdver=1&bc=AAAAgAAAAAAAAA%3d%3d&

7. Noridian Healthcare Solutions, LLC. LCD for Seat Lift Mechanisms (L33801). Revision effective date: 07/01/2016. Available at https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33801&ver=5&SearchType=Advanced&CoverageSelection=Both&NCSelection=NCA%7cCAL%7cNCD%7cMEDCAC%7cTA%7cMCD&ArticleType=SAD%7cEd&PolicyType=Both&s=38&KeyWord=seat+lift&KeyWordLookUp=Title&KeyWordSearchType=Exact&kq=true&bc=IAAAACAAAAAAAA%3d%3d&.

Codes:
(The list of codes is not intended to be all-inclusive and is included below for informational purposes only. Inclusion or exclusion of a procedure, diagnosis, drug or device code(s) does not constitute or imply authorization, certification, approval, offer of coverage or guarantee of payment.)

CPT*

E0172
E0627
E0629