Patient Lifts
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This policy governs coverage of patient lift equipment (hydraulic, electric, ceiling, and seat-lift mechanisms) for Blue Cross Blue Shield of North Carolina members and describes medical necessity, exclusions, coding, and documentation requirements for providers and DME suppliers.
No material clinical or coverage changes in this revision.
Coverage Criteria
When Patient Lifts are Covered
Covered when ALL of the following are met:
BCBSNC covers hydraulic patient lifts (for example, manual/Hoyer-type lifts) when they meet the medical necessity criteria described below. Covered device types include hydraulic/manual patient lifts and related parts, accessories, repair, adjustment, or replacement when criteria are met. Devices used solely for environmental accommodation or primarily for comfort/convenience are excluded from coverage. Examples of excluded device categories include electric patient lifts (e.g., Saralift), seat lift chair mechanisms, and ceiling lifts. Providers should verify member benefits for any additional plan-specific exclusions or limitations.
Patient lifts are not covered when the medical necessity criteria are not fully satisfied. Coverage is not provided for use that is primarily for the convenience of caregiver(s) or when the device includes electrical or mechanical features that principally provide convenience rather than medical benefit. Devices provided by a facility or setting that would customarily supply such equipment are also excluded. Verify member eligibility and any required prior authorization before rental or purchase.
Medical Necessity
Hydraulic Lift Medical Necessity
Hydraulic patient lifts are medically necessary when ALL of the following are satisfied:
Coding / HCPCS
| E0621 | exact description from document |
| E0630 | exact description from document |
| E0640 | exact description from document |
| E0641 | exact description from document |
| E0642 | exact description from document |
| E1035 | exact description from document |
| E1036 | exact description from document |
| E0172 | exact description from document |
| E0625 | exact description from document |
| E0627 | exact description from document |
Provider Actions & Billing
Verify eligibility and prior authorization
Verify member eligibility and whether prior approval or preauthorization is required for rental or purchase of patient lift equipment; confirm the applicable HCPCS/E-codes when submitting requests or claims.
Supplier/provider responsibilities and benefit verification
Supplier and provider must ensure the device, delivery and billing comply with plan DME requirements and credentialing; confirm benefit coverage varies by member benefit design and place of service before furnishing equipment.
- DME suppliers must meet eligibility and/or credentialing requirements defined by the Plan to be eligible for reimbursement.
- Member benefits may vary according to benefit design; review the member’s benefit booklet and place of service rules prior to providing equipment.
Required documentation: physician order and medical records
Maintain a signed and dated physician’s order for the patient lift on file; be prepared to produce complete medical records and letters of support when requested for medical necessity review.
- An order for the patient lifts which is signed and dated by the ordering physician must be kept on file by the supplier.
- BCBSNC may request medical records; letters of support are useful but are not sufficient unless they include all specific information needed for a medical necessity determination.
Denial triggers: medical necessity not met
Claims will be denied if the medical necessity criteria are not fully met — examples include devices provided primarily for caregiver convenience, devices with electrical/mechanical convenience features, or equipment supplied in settings that typically provide such equipment.
- Use of patient lifts for convenience of the caregiver(s) is not covered.
- Electrical or mechanical features that primarily serve a convenience function are not covered.
- Equipment is not covered when the patient resides in a facility or setting that would typically provide such equipment.
Documentation Requirements
Physician order and documentation must be on file
A signed and dated physician order must be on file; BCBSNC may request medical records and letters of support which must include all information needed to make a medical necessity determination.
- Supplier must retain the ordering physician’s signed and dated order.
- If medical records are requested, ensure documentation contains all specific information required for medical necessity review; letters alone are insufficient unless complete.
Rental and Purchase Rules
| Item | Rule / Notes |
|---|---|
| Rental vs. Purchase | DME benefits for rental versus purchase will be determined on an individual consideration basis; refer to the DME policy. Member eligibility and any prior approval or preauthorization necessary for the rental/purchase of equipment should be verified. |
Definitions & Background
Patient lifts are assistive devices that enable movement, transfer, and positioning of an immobilized patient. Hydraulic (manual) lifts—often referred to by the trade name Hoyer—use mechanical or hydraulic systems to lift and transfer patients who cannot perform independent transfers. These devices facilitate transfers to and from beds, chairs, and stretchers and can be necessary to prevent immobility-related decline when transfers cannot be performed independently and would otherwise render the patient bed confined.
Not Covered
The policy explicitly states that electric patient lifts (e.g., Saralift) are considered convenience items and are not covered. Similarly, seat lift chair mechanisms (motorized chairs that lift a patient from sitting toward standing) and ceiling lifts (lift or walking slings mounted in ceiling tracks) are excluded. Equipment used for environmental accommodation—such as chair lifts, stair lifts, home elevators, standing frames, and ramps—or any durable medical equipment that is primarily for comfort or convenience is not covered under most health benefit plans.
Revision History
Original policy issued.
Policy revised to state noncoverage for electric patient lifts, seat lift mechanisms, and ceiling lifts; repair/replacement rules clarified and HCPCS codes added; effective date noted.
Biennial review with administrative reorganization of physician order and facility residence statements and minor clarifications; HCPCS codes E0641 and E0642 later added in 2007.
Billing/Coding section updated to add codes E1035, E1036, and E0172; policy noticed Oct 30, 2015 for effective date Dec 30, 2015.
Specialty Matched Consultant Advisory Panel and Medical Director review completed; references and review notes updated as part of routine annual review.
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