CurrentAmeriHealth Caritas LouisianaPolicy CCP.4031

Standing Frame

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This policy governs coverage determinations for standing frames, also called standers or standing aids, for AmeriHealth Caritas Louisiana Medicaid members who rely on a wheelchair or are unable to stand. Coverage is evaluated case by case based on medical necessity, plan benefits, and applicable Louisiana and federal requirements.

Policy Summary

PayerAmeriHealth Caritas Louisiana

PolicyStanding Frame

Policy CodePolicy CCP.4031

Change TypeAdministrative reference update

Effective DateN/A

Last ReviewJan 1, 2026

Next Review DateMay 1, 2027

Key ActionSubmit the PA-01 form, physician prescription, completed BHSF-SF-Form 1 evaluation, and original manufacturer price for prior authorization.

SourceLink

POLICY UPDATE CHANGES

The policy references were updated in January 2026.

1commonly submitted HCPCS code listed

8listed standing-frame coverage criteria

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CurrentAmeriHealth Caritas LouisianaPolicy CCP.4031

Standing Frame

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Policy Summary

PayerAmeriHealth Caritas Louisiana

PolicyStanding Frame

Policy CodePolicy CCP.4031

Change TypeAdministrative reference update

Effective DateN/A

Last ReviewJan 1, 2026

Next Review DateMay 1, 2027

Key ActionSubmit the PA-01 form, physician prescription, completed BHSF-SF-Form 1 evaluation, and original manufacturer price for prior authorization.

SourceLink

POLICY UPDATE CHANGES

The policy references were updated in January 2026.

1commonly submitted HCPCS code listed

8listed standing-frame coverage criteria

Standing Frame Coverage Criteria

Standing frame medical necessity

A standing frame may be considered when the member meets all of the following criteria.

Contracture risk and tolerance
- High risk for lower-extremity contractures: The member is at high risk for lower-extremity contractures that cannot be improved with other interventions, including stretching, medications, serial casting, splinting, and modalities.
- Tolerance of upright position: The member can tolerate a standing or upright position on the foot and ankle.
Functional status and alternatives
- Non-ambulatory or unable to stand: The member is non-ambulatory or unable to stand due to a condition such as a neuromuscular or congenital disorder, including an acquired skeletal abnormality.
- Cost-effective alternatives tried: The member has tried more cost-effective alternatives and still requires a stander.
- No walker or gait trainer anticipated: The member does not have a walker or gait trainer, and use of one is not anticipated.
Demonstrated benefit and use
- Improved or maintained function: The member has demonstrated improved mobility, function, or physiologic symptoms, or has maintained status with the requested stander.
- Home standing program: The member is able to follow a home standing program using the requested stander.
- Personal use: The equipment is for personal use only and will not be used at school.

Coverage is not provided when the member has complete paralysis of the lower extremities.

Coverage is not provided when there is no expected improvement in mobility or maintenance of function.

Coverage is not provided when the anticipated functional benefits of standing can be achieved through less-costly alternatives.

Mobile or dynamic standers are not covered, including self-propelled standers and standers with powered mobility.

Active standers that allow movement of the arms and legs while in a standing position are not covered.

Coverage is not provided for members with syncope, orthostatic hypotension, postural tachycardia syndrome, osteogenesis imperfecta, osteoporosis, other brittle-bone diseases, or hip subluxation.

Coverage is not provided when the member has hip and knee flexion contractures greater than 20 degrees.

Coverage is not provided when the member has a gait trainer or ambulatory device.

A standing frame is not medically necessary when there is no expected improvement in mobility or maintenance of function, or when the anticipated functional benefits can be achieved through a less-costly alternative.

Coding and Coverage Parameters

Related CodesHCPCS

E0638

Standing frame/table system, one position (e.g., upright, supine or prone stander), any size including pediatric, with or without wheels

Hip and Knee Flexion Contracture

Affected jointsHip and knee

Contracture thresholdMore than 20 degrees

Coverage implicationHip and knee flexion contractures of more than 20 degrees are excluded from coverage

Provider Authorization and Coverage Actions

Prior Authorization

Submit Prior Authorization Package

Submit the prior authorization package for the requested standing frame before delivery or billing. The submission must include the required medical-necessity documentation identified below.

Step Therapy

Try Lower-Cost Alternatives First

The member must have tried more cost-effective alternatives and still require a standing frame. Coverage may be denied when the anticipated functional benefits of standing can be achieved through a less-costly alternative.

Documentation Required

Required Authorization Documentation

Submit all documentation required to support medical necessity for the standing frame.

Standing Frame Overview

A standing frame is assistive technology that supports a member in an upright position as an alternative to sitting in a wheelchair. It may be considered for non-ambulatory members or members who are unable to stand because of neuromuscular, congenital, or acquired skeletal conditions.

Key Terms

Standing Frame

DefinitionAssistive technology that supports a member in the standing position

Intended member populationA member who relies on a wheelchair for mobility

Positioning purposeProvides an alternative to sitting in a wheelchair by supporting the member in a standing position

Stander

DefinitionA standing frame

Synonymous termsStander, standing aid, and standing device

FunctionSupports the member in the standing position as an alternative to sitting in a wheelchair

Medical Necessity Determination

Standing frame criteria

The member must meet all listed standing-frame criteria.

Standing frame criteria: The member must be at high risk for lower-extremity contractures that cannot be improved with other interventions, including stretching, medications, serial casting, splinting, and modalities; tolerate a standing or upright position on the foot and ankle; be non-ambulatory or unable to stand due to conditions such as neuromuscular or congenital disorders, including acquired skeletal abnormalities; have tried more cost-effective alternatives and still require a stander; not have a walker or gait trainer, with no anticipated need for one; demonstrate improved mobility, function, or physiologic symptoms, or maintain status with the requested stander; be able to follow a home standing program using the requested stander; and use the equipment for personal use only and not at school.

Required Authorization Documentation

Documentation Required

Support medical necessity with documentation

Submit documentation that supports the medical necessity of the standing frame, including the PA-01 form, physician prescription, completed BHSF-SF-Form 1, and original manufacturer price.

Documentation Required

Complete the evaluation form in full

The BHSF-SF-Form 1 must be completed in its entirety by a Louisiana State Licensed Physician and a Physical or Occupational Therapist.

Excluded Services and Equipment

Not covered: complete paralysis of the lower extremities; mobile or dynamic standers, including self-propelled standers or standers with powered mobility; and active standers that allow movement of the arms and legs in a standing position.