CurrentCareSource GeorgiaPolicy N/A

Standing frames (non-powered) coverage criteria

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Policy governing medical necessity review and coverage criteria for non-powered standing frames (standers) for CareSource Marketplace members in specified states; applies to providers requesting DME for members who cannot stand independently.

Policy Summary

PayerCareSource Georgia

PolicyStanding frames (non-powered) coverage criteria

Policy CodePolicy N/A

Change TypeMaterial operational requirement added

Effective DateMay 1, 2026

Last ReviewFeb 11, 2026

Next Review DateN/A

Key ActionObtain prior authorization and submit required documentation including device details, OT/PT face-to-face evaluation with specified elements, prescription, and demonstration of safe home use.

SourceLink

POLICY UPDATE CHANGES

Added requirement for evaluation with a qualified professional and added 'type of stander' to trial, training, and demonstrated safe use in the home.

5replacement interval (years)

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CurrentCareSource GeorgiaPolicy N/A

Standing frames (non-powered) coverage criteria

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Sign up for all CareSource Georgia policy alerts

Know when CareSource Georgia releases new policies or updates existing guidance.

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Policy Summary

PayerCareSource Georgia

PolicyStanding frames (non-powered) coverage criteria

Policy CodePolicy N/A

Change TypeMaterial operational requirement added

Effective DateMay 1, 2026

Last ReviewFeb 11, 2026

Next Review DateN/A

SourceLink

POLICY UPDATE CHANGES

Added requirement for evaluation with a qualified professional and added 'type of stander' to trial, training, and demonstrated safe use in the home.

5replacement interval (years)

marketplaces covered

excludedpowered frames coverage

requiredOT/PT evaluation

Coverage Criteria

Initial medical necessity

Covered when ALL of the following are met

Initial requirements: 1) Device information provided: manufacturer, model number, type of stander, part number if applicable, and an itemized list of additional attachments/accessories with prices when applicable. 2) Face-to-face evaluation by a qualified professional (OT or PT) that includes: recommendation of a postural management program with supported standing; the type of stander recommended (e.g., prone, supine, vertical, multipositional, sit-to-stand); goals of the program and stander; specific dosing for the stander; and a documented trial demonstrating the recipient can tolerate the recommended dose. 3) A prescription that specifies length of validity, is dated and signed by an appropriately licensed/certified clinician with a professional relationship to the recipient, and includes a diagnosis documenting a neuromuscular condition or developmental delay that impairs independent standing. 4) Documentation that the member or parent/guardian received training in use of the requested type of stander (training may be completed during a scheduled therapy session). 5) Documentation showing the member or parent/guardian demonstrated safe use of the requested type of stander in the home setting (therapy session documentation of trials is acceptable). 6) Documentation that device use is reasonably expected to provide therapeutic benefits or enable tasks otherwise not possible (examples include prevention of atrophy; improved strength/circulation; prevention of decubitus ulcers; maintenance of bone/skin integrity; reduced lower extremity swelling; improved range of motion and skeletal development; improved kidney/bladder/bowel function; decreased spasms; improved cardiovascular endurance; prevention/decrease of contractures or progressive scoliosis; improved social interaction/psychological well-being; increased ADL performance). 7) No contraindications to supported standing (examples include healing fracture or severe osteoporosis precluding weight bearing; significant hip/knee/ankle contractures preventing standing; compromised cardiovascular/respiratory status requiring frequent monitoring; significant inflexible skeletal deformities; lack of standing tolerance; postural hypotension).

Based on policy section I.A.1-8

Replacement

Replacement covered when BOTH conditions are met

Replacement after 5 years: 1) Original medical necessity criteria continue to be met. 2) Device is out of warranty and cannot be refurbished or adequately repaired.every 5 years

Replacement of a non-powered standing frame is considered medically necessary after 5 years when criteria met

Coverage of non-powered standing frames is conditional and available when ALL of the following are documented: device specifics (manufacturer, model, type, part number and any itemized accessories/prices); a face-to-face evaluation by an occupational or physical therapist that includes a recommended postural management program with supported standing, the type of stander recommended, program goals, and specific dosing with a documented trial demonstrating tolerance; a dated prescription signed by an appropriate licensed clinician that includes the diagnosis (neuromuscular condition or developmental delay impairing independent standing); documentation of training of the member/guardian in device use and demonstration of safe use in the home; evidence that the device is reasonably expected to provide therapeutic benefit or enable tasks otherwise not possible; and documentation that there are no contraindications to supported standing.

Replacement of a non-powered standing frame is considered medically necessary after 5 years when BOTH of the following are met: the original medical necessity criteria continue to be satisfied, and the device is out of warranty and cannot be refurbished or adequately repaired. CareSource may request proof of delivery, documentation of routine maintenance/repairs, and annual review of continued need by a qualified provider as part of ongoing coverage verification.

Powered standing frames, including electric, motorized, or powered standing frames, are explicitly not covered under this policy. Items or services that remain covered under a manufacturer or dealer warranty are similarly not separately reimbursable. Additionally, DME that duplicates or conflicts with an item already in the recipient's possession, and replacements for devices damaged by misuse, abuse, or negligence, are not covered.

Device-specific Medical Necessity

Device-specific medical necessity

Device-specific medical necessity mirrors the general coverage criteria: see 'Initial medical necessity' for required device details, face-to-face OT/PT evaluation elements (postural management recommendation, type of stander, program goals, dosing, documented trial), prescription requirements, training and demonstrated safe home use, documentation of expected therapeutic benefit, and absence of contraindications.

Device-specific medical necessity aligns with coverage.criteria_sets 'Initial medical necessity'

Rental, Purchase and Replacement Rules

Equipment	Rental / Purchase Rule	Replacement Interval
Non-powered standing frames (e.g., prone, supine, vertical, multipositional, sit-to-stand)	Purchase	Every 5 years when original medical necessity criteria continue to be met and the device is out of warranty and cannot be refurbished or adequately repaired

inv-16: non-powered standing frames replacement interval — every 5 years

Replacement intervalNon-powered standing frames — replacement considered medically necessary after 5 years when original medical necessity criteria continue to be met and the device is out of warranty and cannot be refurbished or adequately repaired.

Condition 1Original medical necessity criteria continue to be met (see Initial medical necessity requirements).

Condition 2Device is out of warranty and cannot be refurbished or adequately repaired.

inv-05: Replacement interval summary (5 years)

Replacement interval summaryReplacement of a non-powered standing frame is considered medically necessary after 5 years when replacement criteria are met.

Required demonstrating criteria

Provider Actions & Requirements

Prior Authorization

Prior authorization required

CareSource requires prior authorization for non-powered standing frames; requests will be reviewed for medical necessity on a case-by-case basis after submission of all required documentation.

Note

Provider impact / policy highlights

Providers should be aware this policy applies to non-powered standing frames only and that CareSource may request additional evidence (e.g., proof of delivery, maintenance records, annual reviews) which can affect coverage determinations.

Policy excludes electric/motorized/powered standing frames (not covered).
CareSource may request proof of delivery, documentation of maintenance/repairs, or annual review of continued need.

Documentation Required for Prior Authorization

Billing Rule

Documentation required for prior authorization review

For prior authorization review, include full device specifics, a face-to-face OT/PT evaluation with all required elements, a prescription with dated clinician signature and diagnosis, and documentation of training and demonstrated safe home use.

Device specifics: manufacturer, model number, type of stander, part number if applicable, and itemized list of attachments/accessories with prices
Face-to-face OT/PT evaluation: recommendation of a postural management program with supported standing; type of stander; program goals; specific dosing; documented trial demonstrating tolerance
Prescription: length of validity, dated signature of an appropriately licensed/certified clinician, and recipient diagnosis documenting neuromuscular condition or developmental delay
Training and home-use demonstration documentation (therapy session notes may suffice)

Coding & Billing Notes

inv-05: Replacement interval key value (5 years) — coding-related replacement guidance

Coding-related replacement guidanceReplacement allowed after 5 years when medical necessity continues and device is out of warranty/unrepairable; document warranty status and repair attempts for prior authorization.

Documentation to includeProvide device details (manufacturer, model, type, part number, accessories) and proof device is no longer serviceable or under warranty.

Prior authorization noteCareSource reviews medical necessity requests for non-powered standing frames on a case-by-case basis once required documentation is submitted.

Definitions

inv-11: Durable Medical Equipment (DME) definition

DefinitionDurable Medical Equipment (DME) — A covered durable medical equipment item, prosthetic device, orthotic device, or medical supply furnished by an eligible provider to an eligible recipient that can withstand repeated use, is primarily and customarily used to serve a medical purpose, is not useful in the absence of illness or injury, and is not worn in or on the body.

Covered item characteristicsCan stand repeated use; primarily medical purpose; not useful without illness/injury.

Provider requirementMust be furnished by an eligible provider to an eligible recipient to qualify as DME.

inv-12: Activities of Daily Living (ADLs) definition

DefinitionActivities of Daily Living (ADLs) — Fundamental skills required to independently care for oneself.

Relevance

Background

Supported standing is used as an adjunctive therapeutic practice for individuals with neuromuscular conditions or developmental delays who cannot stand or walk independently. Home-based standing programs and supported standing equipment are intended to prevent contracture and deformity, reduce pain and asymmetry, and provide benefits such as improved range of motion, preservation of bone integrity, improved bowel and bladder function, decreased spasticity, reduced risk of pressure injuries, and psychological and social benefits. These clinical goals inform the policy’s requirement that a qualified OT or PT document a postural management program, specific dosing, and a demonstrated trial and expected therapeutic benefit prior to coverage determination.

This policy applies to non-powered standing frames (e.g., prone, supine, vertical, multipositional, and sit-to-stand standers). Coverage decisions are contingent on documentation of training, demonstrated safe use in the home (which may be performed during scheduled therapy sessions), and the absence of contraindications such as unstable fractures, severe osteoporosis precluding weight bearing, significant joint contractures that prevent standing, compromised cardiopulmonary function requiring frequent monitoring, significant rigid skeletal deformities, inability to tolerate standing, or postural hypotension.

Not Covered

Items not covered under this policy include electric/motorized/powered standing frames, any items or services that are covered under a manufacturer or dealer warranty, and DME that duplicates or conflicts with equipment already in the recipient’s possession. Replacements for devices damaged by misuse, abuse, or negligence are also not reimbursable. CareSource reserves the right to request additional information if medical necessity is insufficiently documented.

Policy Summary

PayerCareSource Georgia

PolicyStanding frames (non-powered) coverage criteria

Policy CodePolicy N/A

Change TypeMaterial operational requirement added

Effective DateMay 1, 2026

Last ReviewFeb 11, 2026

Next Review DateN/A

SourceLink

On This Page

The original medical necessity criteria must continue to be met at time of replacement.

Warranty/repair requirementDevice must be out of warranty and cannot be refurbished or adequately repaired.

Documentation Required

Required documentation for prior authorization

Submit complete documentation for prior authorization including device details, a face-to-face OT/PT evaluation with specified elements, a valid prescription, and training/home-use documentation.

Device details: manufacturer, model number, type of stander, part number (if applicable), and itemized attachments/accessories with prices as applicable.
Face-to-face evaluation by an OT or PT including recommendation of a postural management program with supported standing; type of stander recommended; program and stander goals; specific dosing; and documented trial demonstrating tolerance.
Prescription: length of validity, dated signature of an appropriately licensed/certified clinician, and recipient diagnosis documenting neuromuscular condition or developmental delay impairing ability to stand independently.
Documentation that member or parent/guardian received training in use of the requested type of stander and demonstrated safe use in the home (therapy session documentation may suffice).

Denial Risk

Denial triggers — incomplete documentation or contraindications

Requests may be denied if required documentation is incomplete or if contraindications to supported standing are present.

Missing device specifics (manufacturer, model, type, part number, accessories/prices) may lead to denial.
Absent or insufficient face-to-face OT/PT evaluation (missing recommendation, type of stander, goals, dosing, or documented trial) may trigger denial.
Incomplete prescription (missing validity period, dated clinician signature, or diagnosis) can result in denial.
Lack of training documentation or failure to demonstrate safe home use may cause denial.
Documented contraindications (e.g., healing fracture, severe osteoporosis, significant contractures, compromised cardio/respiratory status, inability to tolerate standing, postural hypotension) are denial triggers.

Improved performance of ADLs is listed as a potential therapeutic benefit of standing frame use.

Clinical implicationDocumentation should demonstrate how the device is expected to improve ADLs when used as prescribed.

inv-13: Postural Management definition

DefinitionPostural Management — A multi-disciplinary approach incorporating a comprehensive schedule of daily and night-time positions, equipment, and physical activity to help maintain or improve body structures and function and increase activity and participation.

Program elementsIncludes positions, equipment (such as standing frames), and activity to prevent contracture, deformity, and maintain joint range of motion.

Documentation expectationFace-to-face evaluation must recommend a postural management program that includes supported standing and specify program goals and dosing.