CurrentAetnaPolicy 0459

Seat Lifts and Patient Lifts

Clinical policy governing medical necessity, coverage, and exclusions for seat lift mechanisms and patient lifts as durable medical equipment for Aetna members.

Policy Summary

PayerAetna

PolicySeat Lifts and Patient Lifts

Policy CodePolicy 0459

Change TypeNo material change

Effective DateSep 17, 2000

Next Review DateMay 9, 2024

Key ActionObtain and document medical necessity criteria and prior authorization evidence for HCPCS-coded seat lifts or patient lifts.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

19HCPCS codes listed in policy

4medical necessity criteria (seat lifts)

units=15minrepair UOS table

3additional link sections

Coverage Criteria

inv-01: Seat lifts - medically necessary

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Seat lift criteria: 1) The member is incapable of standing up from a regular armchair at home; 2) The member has severe arthritis of the hip or knee, or has severe neuromuscular disease; 3) The seat lift mechanism is prescribed to effect improvement, or arrest or retard deterioration in the member's condition; 4) Once standing, the member has the ability to ambulate.

All four conditions required. Medically necessary seat-lift mechanisms operate smoothly, can be controlled by the member, and assist standing/sitting without other assistance. Spring-release catapult-type mechanisms are considered experimental and investigational.

inv-02: Patient lifts - medically necessary

Covered when ALL of the following are met

Patient lift criteria: 1) Transfer between bed and a chair, wheelchair, or commode requires the assistance of more than 1 person; 2) Without the use of a lift, the member would be bed-confined.

Both conditions required. Examples of medically necessary patient lifts include Hoyer, Lift-Aid, Trans-Aid, and Sara lifts. Patient lifts are experimental and investigational for other indications.

Coding

HCPCS codes listedHCPCS

E0170	Commode chair with integrated seat lift mechanism, electric, any type.
E0171	Commode chair with integrated seat lift mechanism, non-electric, any type.
E0172	Seat lift mechanism placed over or on top of toilet, any type.
E0621	Sling or seat, patient lift, canvas or nylon.
E0625	Patient lift, bathroom or toilet, not otherwise classified.
E0627	Seat lift mechanism incorporated into a combination lift-chair mechanism [except electric].
E0629	Separate seat lift mechanism for use with patient owned furniture - non-electric.
E0630	Patient lift; hydraulic, with seat or sling.
E0635	Patient lift; electric, with seat or sling.
E0636	Multipositional patient support system, with integrated lift, patient accessible controls.

1–10 of 19

1/2

ICD-10 diagnosis codes listedICD-10

M12.151 - M12.169
M12.551 - M12.569
M12.851 - M12.869
M13.851 - M13.869
M15.0 - M15.9
M16.0 - M17.9	Arthritis of hip and/or knee.
G70.00 - G70.9	Myoneural disorders
G73.1 - G73.7

inv-07: multi-positional transfer system weight capacity examples

E1035Multi-positional patient transfer system, with integrated seat, operated by caregiver, patient weight capacity up to and including 300 lbs.

E1036Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs.

Usage noteCodes differentiate by patient weight capacity for multi-positional transfer systems; select E1035 when capacity ≤ 300 lbs and E1036 when capacity > 300 lbs.

Medical Necessity Criteria

inv-21: Seat lift DME criteria

Seat lift DME criteria: See seat lift criteria in coverage module.

Equipment must operate smoothly, be member-controlled, and effectively assist the member in standing up and sitting down without other assistance; spring-release catapult mechanisms are excluded.

inv-22: Patient lift DME criteria

Patient lift DME criteria: See patient lift criteria in coverage module; includes electric, hydraulic, moveable and fixed patient lifts and examples (Hoyer, Lift-Aid, Trans-Aid, Sara).

When used only in a bathroom, code as a bathroom/toilet patient lift; installation costs for fixed systems used outside the bathroom are included in the device payment.

Provider Actions & Prior Authorization

Prior Authorization

Prior Authorization / Documentation Expectations

Prior authorization is implied for HCPCS-coded equipment when coverage is contingent on meeting medical necessity criteria. Providers should obtain prior authorization where applicable and ensure documentation supports all medical necessity and repair justifications.

Medically necessary seat lifts and patient lifts require documentation that the member meets all listed clinical criteria.
Repairs: include units-of-service justification per Appendix (one UOS = 15 minutes).
HMO plans follow Medicare rules; bathroom/toilet patient lifts are non-covered convenience items under Medicare but may be covered under traditional plans if criteria are met.

Documentation Required

Clinical Justification and Repair Documentation

Documentation should fully support the clinical criteria for medical necessity and any request for repair services. Include clinical findings (e.g., inability to stand from a regular armchair, diagnosis of severe arthritis or neuromuscular disease, need for supine transfer), physician prescription, and justification for replacement accessories (e.g., canvas/nylon sling).

Appendix repair UOS table must be referenced for repair claims.
Document that transfer requires more than one person for patient lifts to qualify as DME.

Denial Risk

Non-Covered Device Categories

The following device categories are not covered: van lifts, wheelchair lifts/ramps, ceiling lifts (home modifications), platform/stair lifts, stairway elevators, and electric powered recliners/elevating seats. Motorized electric lifts considered convenience items are not medically necessary.

Van lifts (for loading wheelchairs into vehicles) — not DME.
Wheelchair lifts or ramps (e.g., Wheel-O-Vator) — not DME.
Ceiling lifts and platform/stair lifts/stairway chairs/elevators — considered home modifications and non-covered.
Electric powered recliners and elevating seats — not covered (not primarily medical).

Note

Additional Provider Notes

No specific denial triggers, step therapy requirements, or additional documentation links are specified in these sections beyond the general documentation and prior authorization expectations noted above. For supplemental resources and program provisions, refer to Aetna's glossary and legal/program pages.

No step therapy requirements mentioned in these chunks.
No additional, specific documentation requirements beyond clinical justification and repair documentation noted here.
External links provided — Aetna is not responsible for external content.

Rental & Purchase Rules

Equipment	Rental / Purchase rule
Patient lift, fixed system (ceiling- or wall-mounted, used in a room other than the bathroom)
Capped rental — installation costs are included in the payment for the device (no separate payment for installation)
Patient lift, bathroom/toilet (attached to toilet, ceiling, floor, wall, or freestanding for transfers in bathroom)
When device is used only in a bathroom it is coded as a bathroom/toilet patient lift; capped rental applies with installation included in device payment
Toilet seat lift mechanism (attached to toilet; manual or electric; raises seat with or without forward tilt)
Treated as DME with installation not separately payable; included in device payment when applicable

Documentation Requirements

Documentation Required

Support clinical criteria and repair justification in documentation

Provide documentation that explicitly demonstrates the member meets the specific medical necessity criteria for the requested seat lift or patient lift and include justification for any repair or replacement based on the policy’s allowed units of service.

For seat lifts: document inability to stand from a regular armchair, diagnosis (severe hip/knee arthritis or severe neuromuscular disease), treatment intent, and ambulatory ability once standing.
For patient lifts: document need for assistance of more than one person for transfers and that the member would be bed-confined without a lift.
For repairs: document part, problem, and time/complexity to support billed repair units (one unit = 15 minutes).

Note

Links to glossary, program provisions, and plan disclosures

See Additional Information for glossary, program provisions, legal notices, plan disclosures and other resources; these links may provide definitions and ancillary policy information but do not replace the clinical documentation required by this policy.

Access Glossary, Program Provisions, and Plan Disclosures links for supplemental definitions and notices.

Definitions & Background

Multi-positional transfer systems and patient lifts are intended to facilitate safe transfers for members who cannot be moved with standard transfer devices. Multi-positional systems can allow supine transfers and adjustment to chair-like positions when a member’s clinical condition requires more than simple manual transfer techniques. Toilet or bathroom lifts raise the seated position to permit ambulation once the member is upright. Repair allowances and units of service for common repairs are provided in the Appendix and apply when documentation supports medical necessity.

inv-17: multi-positional transfer system — definition entry

DefinitionMulti-positional patient transfer system: a device with an integrated seat operated by a caregiver that can be positioned and adjusted to transfer a bed-bound member from supine to a chair-like position with multiple degrees of recline and leg elevation; typically has small castor wheels not accessible by the member and no electric controls.

Typical useIntended to assist caregivers in transferring individuals who cannot be moved with standard transfer devices, including supine transfers.

ExamplesExamples include devices such as the Barton Convertible H-250 Chair (Barton Medical Corporation).

inv-18: patient lift, fixed system — definition and installation cost note

DefinitionPatient lift, fixed system: a device in which the lift mechanism is attached to permanent ceiling tracks or a wall mounting system used in a room other than the bathroom; lift/transport mechanisms may be mechanical or electric.

Installation cost noteNo separate payment is made for installation; all costs associated with installation are included in the payment for the device.

Coding noteWhen a device is only used in a bathroom, it is coded as a bathroom/toilet patient lift (not as a fixed system).

inv-19: toilet seat lift mechanism — definition (manual or electric; attached to toilet)

DefinitionToilet seat lift mechanism: a device with a seat that can be raised with or without a forward tilt while the beneficiary is seated, allowing the member to ambulate once in a more upright position; may be manually operated or electric and is attached to the toilet.

PlacementAttached directly to the toilet; used to raise seated position to facilitate standing or transfer.

OperationMay be manual or electric.

inv-20: Seat Lifts and Patient Lifts — short definition header

Seat Lifts and Patient LiftsDevices that assist members with transfers and rising to standing; includes seat lift mechanisms, patient lifts (moveable and fixed), and multi-positional transfer systems.

ScopeCovers equipment intended to assist caregiver transfers, supine-to-chair adjustments, and toilet-seat elevation to permit ambulation.

Exclusions noteSome lift categories (e.g., ceiling track systems, van lifts, stair lifts) are excluded and considered home modifications or non-covered items per policy exclusions.

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