E0628 Electric Seat Lift Mechanism Reimbursement | OpenPayer

Summary & Overview

HCPCS Level II E0628: Electric Separate Seat Lift Mechanism for Patient Furniture

HCPCS Level II code E0628 denotes an electric, separate seat lift mechanism designed to be fitted to patient-owned furniture to assist with standing and transfers. This equipment component is nationally relevant because it supports mobility and independence for patients with functional limitations, and it intersects with durable medical equipment (DME) coverage policies across major payers. The analysis covers common national payers and Medicare, with payer-specific coverage approaches summarized for Aetna, Blue Cross Blue Shield plans, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn how E0628 is described clinically and operationally, typical sites of service where the device is used, and which payers are commonly involved in coverage decisions. The report outlines benchmarks and policy considerations related to DME components, including common documentation requirements, typical authorization pathways, and service-line implications for home-based mobility equipment providers.

Data not available in the input is clearly noted where applicable. The content is written for a national audience and focuses on coding identity, clinical context, and payer coverage landscape rather than state-specific rules.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareE0628HCPCS Level IIdurable medical equipmentseat lifthome healthmobility aidsDME policybilling guidance

Billing Code Overview

HCPCS Level II code E0628 describes a separate seat lift mechanism for use with patient owned furniture — electric. This item is a durable medical equipment component intended to convert existing chairs or recliners into powered lift seating to assist patients with transfers and standing.

Service type: Durable Medical Equipment - mobility/seat lift component.

Typical site of service: Home or residential setting where the patient’s own furniture is located.

Clinical & Coding Specifications

Clinical Context

A typical patient is an older adult with limited lower extremity strength and mobility who has difficulty standing from a seated position due to conditions such as osteoarthritis, lumbar spinal stenosis, stroke residual weakness, or generalized deconditioning. The patient owns household seating (a recliner or sofa) that is structurally sound but lacks an integrated lift mechanism. A durable medical equipment (DME) supplier evaluates home function, documents the need for a separate seat lift mechanism, and supplies an electric, retrofit lift motor and frame (billing code E0628) to be attached to the patient-owned chair. The workflow includes a home assessment (or clinic evaluation), physician certification/face-to-face visit documenting functional limitations and medical necessity, ordering and coding by the DME supplier, fitting and installation of the electric lift mechanism, patient and caregiver training on safe operation, and documentation of delivery and device functionality for reimbursement and durable medical equipment recordkeeping.

Coding Specifications

Modifier	Description	When to Use
`NU`	New equipment	Use when the `E0628` lift mechanism is brand-new and provided as new, never previously owned equipment.

HCPCS Level II E1808: Dynamic Adjustable Wrist Flexion Device, Soft Interface

HCPCS-E1637-HEMOSTATS-SINGLE-UNIT

HCPCS E1637: Hemostats, Single Unit

HCPCS-E0244-RAISED-TOILET-SEAT-DURABLE-MEDICAL-EQUIPMENT

HCPCS E0244: Raised Toilet Seat

HCPCS-E2625-SKIN-PROTECTION-POSITIONING-WHEELCHAIR-SEAT-CUSHION-22IN-PLUS

HCPCS Level II E2625: Skin Protection and Positioning Wheelchair Seat Cushion, Adjustable

HCPCS-E2295-PEDIATRIC-DYNAMIC-SEATING-ACCESSORY

HCPCS Level II E2295: Pediatric Manual Wheelchair Dynamic Seating Accessory

HCPCS-E1570-ADJUSTABLE-DIALYSIS-CHAIR-ESRD

HCPCS E1570: Adjustable Chair for ESRD Patients

HCPCS-E0785-IMPLANTABLE-INTRASPINAL-CATHETER-REPLACEMENT

HCPCS E0785: Implantable Intraspinal Catheter Replacement

HCPCS-E1632-WEARABLE-ARTIFICIAL-KIDNEY

HCPCS Level II E1632: Wearable Artificial Kidney, Each

HCPCS-E2508-SPEECH-GENERATING-DEVICE-SPELLING-PHYSICAL-CONTACT

HCPCS E2508: Speech-Generating Device, Synthesized Speech, Spelling Access

HCPCS-E0670-SEGMENTAL-PNEUMATIC-APPLIANCE-2-LEGS-AND-TRUNK

HCPCS Level II E0670: Segmental Pneumatic Appliance, 2 Legs and Trunk

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Taxonomy Code	Specialty	Notes
1835P0003X	Physical Medicine & Rehabilitation	Clinicians who evaluate functional need and certify medical necessity for mobility equipment.
2086S0100X	Physical Therapist	Performs functional mobility assessment and training for safe transfer using the lift-equipped chair.
207Q00000X	Internal Medicine	Primary care physicians who document chronic conditions causing impaired sit-to-stand and sign orders.
103T00000X	Orthotist/Prosthetist	May be involved when custom mounting or seating modifications are required for proper device integration.
332B00000X	Medical Equipment Supplier	Supplier taxonomy representing durable medical equipment providers who furnish and install `E0628`.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M16.11`	Unilateral primary osteoarthritis, right hip	Hip osteoarthritis causing pain and weakness that impairs sit-to-stand, supporting need for a seat lift device.
`M17.11`	Unilateral primary osteoarthritis, right knee	Knee osteoarthritis limiting transfer ability and justifying a lift mechanism on home seating.
`M48.06`	Spinal stenosis, lumbar region	Neurogenic claudication and lower extremity weakness that reduce safe standing and transfer ability.
`I69.351`	Cognitive deficits following cerebral infarction, with right sided hemiplegia and hemiparesis	Post-stroke weakness with impaired transfers necessitating powered seat lift to reduce fall risk.
`R26.2`	Difficulty in walking, not elsewhere classified	Functional gait impairment that often coexists with impaired sit-to-stand requiring assistive seating modifications.
`G82.20`	Paraplegia, unspecified	Severe motor deficits requiring environmental modifications such as powered seat lifts to facilitate transfers.
`M62.81`	Muscle weakness (generalized)	Generalized weakness limiting ability to rise from chair, clinical rationale for `E0628`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97530`	Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes	Often used by occupational or physical therapists to train the patient in sit-to-stand transfers and safe use of the seat lift mechanism during therapy sessions prior to or after device delivery.
`97162`	Physical therapy evaluation, moderate complexity	Used when a physical therapist evaluates the patient’s mobility and functional limitations to support medical necessity documentation for `E0628`.
`99456`	Work-related or medical disability evaluation services, by physician	May be used when formal functional capacity assessment is required to document need for home accommodations including a seat lift mechanism.
`99406`	Behavioral counseling for tobacco use — intermediate, 3-10 minutes	Included as an example of commonly billed counseling codes in broader clinic encounters; not directly related to the device but may appear on the same visit when documenting comorbid risk factors.
`99070`	Supplies and materials (excluding drugs), provided by the physician over and above those usually included with the office visit or procedure	Used when clinicians bill for small supplies or accessory components furnished in conjunction with training or installation of the lift mechanism.

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