CurrentCareSourcePolicy N/A

Standing Frames – Non‑powered standing frames (Arkansas)

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Coverage and medical necessity criteria for non-powered standing frames (standers) for Arkansas members, including documentation, evaluation, replacement, and exclusions; applies to CareSource members in Arkansas (NC not listed).

Policy Summary

PayerCareSource

PolicyStanding Frames – Non‑powered standing frames (Arkansas)

Policy CodePolicy N/A

Change TypeAdded material requirement

Effective DateMay 1, 2026

Last ReviewFeb 11, 2026

Next Review DateN/A

Key ActionSubmit Arkansas DMS-679A or dated prescription plus face-to-face evaluation with OT/PT/RESNA-qualified professional including documented trial, device details, and training evidence prior to authorization.

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.

5 yrsreplacement interval

6 moDMS-679A validity

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CurrentCareSourcePolicy N/A

Standing Frames – Non‑powered standing frames (Arkansas)

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Policy Summary

PayerCareSource

PolicyStanding Frames – Non‑powered standing frames (Arkansas)

Policy CodePolicy N/A

Change TypeAdded material requirement

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.

5 yrsreplacement interval

6 moDMS-679A validity

excludedpowered frames

face-to-faceeval required

Coverage and Medical Necessity Criteria

inv-01: Initial coverage criteria

Covered when ALL of the following are met:

Clinical diagnosis: Specific recipient diagnosis documenting a neuromuscular condition (e.g., multiple sclerosis, cerebral palsy, spinal cord injury, stroke) or documented developmental delay impairing the recipient's ability to stand independently.

Prescription/form: Arkansas DMS-679A (valid for 6 months) which may serve as the provider prescription if medical necessity and orders are documented adequately, or a provider prescription with dated signature of an appropriately Arkansas‑licensed PCP or APRN within scope of practice.

CareSource may request additional information if medical necessity is not adequately documented.

Device details: Stand er information including manufacturer, model number, type of stander, part number if applicable, and an itemized list of additional attachments and accessories with individual prices when not included with the basic stander.

Face‑to‑face evaluation: A face‑to‑face evaluation by a qualified professional (occupational therapist, physical therapist, or RESNA‑certified professional) that includes: recommendation of a postural management program with supported standing; type of stander recommended (e.g., prone, supine, vertical, multipositional, sit‑to‑stand); goals of the program and device; specific dosing to meet goals; and a documented trial demonstrating the recipient can tolerate the recommended dose.

Training and home demonstration: Documentation showing the member or parent/guardian received training in use of the requested type of stander and demonstrated safe use of the stander in the home setting (therapy session documentation acceptable).

Therapeutic benefit expectation: Documentation that use of the device can reasonably be expected to provide therapeutic benefits or enable performance of tasks otherwise not possible due to the diagnosis (examples include prevention of atrophy, improved circulation, prevention of pressure injuries, maintenance of bone/skin integrity, improved range of motion, improved bowel/bladder function, decreased spasms, prevention of contractures or progressive scoliosis, improved ADLs, and psychosocial benefits).

Contraindications absent: No contraindications to a supported standing program are present (e.g., healing fracture or severe osteoporosis precluding weight bearing; significant hip/knee/ankle contractures preventing standing; compromised cardiovascular or respiratory systems requiring frequent monitoring; significant inflexible skeletal deformities; lack of standing tolerance; postural hypotension).

inv-02: Replacement criteria

Replacement coverage — Covered when ALL of the following are met:

Replacement interval and condition: Replacement of a non‑powered standing frame is medically necessary after 5 years when the medical necessity criteria above are met and the device is out of warranty and cannot be refurbished or adequately repaired.5 years

The policy excludes the following from coverage: electric, motorized, or powered standing frames. Items or services that remain under a manufacturer or dealer warranty are not covered. The policy also excludes DME that would duplicate or conflict with another item already in the recipient’s possession, and replacement items or previously approved equipment that have been damaged by perceived misuse, abuse, or negligence.

A supported standing device is not covered when contraindications to a supported standing program exist. Examples include: healing fracture or severe osteoporosis that preclude weight bearing; significant hip, knee, or ankle contractures that prevent standing; compromised cardiovascular or respiratory systems requiring frequent monitoring while in a stander; significant inflexible skeletal deformities; lack of standing tolerance (unable to maintain standing due to minimal or no residual lower‑extremity strength); and postural hypotension.

DME Medical Necessity Details

inv-14: DME medical necessity

Non‑powered standing frames are medically necessary when the following device‑ and patient‑specific criteria are met:

Device type: Non‑powered (manual) standing frames of types including prone, supine, vertical, multipositional, and sit‑to‑stand.

Powered or motorized standing frames are excluded.

Clinical indication: Recipient has a neuromuscular diagnosis or documented developmental delay that impairs independent standing.

Evaluation and trial: Face‑to‑face evaluation by an occupational therapist, physical therapist, or RESNA‑certified professional including recommendation of a postural management program with supported standing; specified type of stander; program and device goals; specific dosing; and a documented trial demonstrating tolerance of the recommended dose.

Coding and Replacement Interval

No explicit CPT/HCPCS/ICD codes listedmixed

No codes listed

inv-06: Replacement interval — 5 years

Replacement intervalReplacement of a non-powered standing frame is considered medically necessary after 5 years when medical necessity criteria are met and the device is out of warranty and cannot be refurbished or adequately repaired.

Condition for replacementDevice must be out of warranty and cannot be refurbished or adequately repaired.

PrerequisiteOriginal medical necessity criteria for the device must still be met at time of replacement.

Provider Requirements, Prior Authorization, and Denial Triggers

Prior Authorization

Prior Authorization Required

CareSource will review medical necessity requests for non-powered standing frames on a case-by-case basis. Prior authorization is required and will be granted only after submission of all required documentation listed below. Arkansas DMS-679A may serve as the provider prescription if it includes adequate medical necessity and order information. CareSource reserves the right to request additional information if medical necessity is not adequately documented.

Prior authorization required for new equipment and replacements (replacement considered medically necessary after 5 years when device is out of warranty and cannot be refurbished or adequately repaired).
Acceptable prescribers: Arkansas-licensed PCP or APRN; dated signature required on Arkansas DMS-679A or separate prescription.
Submit stander information: manufacturer, model number, type of stander, part number (if applicable), and itemized list of attachments/accessories with prices if not included.
Include specific recipient diagnosis documenting a neuromuscular condition or developmental delay impairing independent standing.
Include a face-to-face evaluation by an OT, PT, or RESNA-certified professional with: recommendation of a postural management program including supported standing; type of stander recommended; program goals tied to the requested stander; specific dosing; and documentation of a trial demonstrating tolerance of the recommended dose.
Provide documentation of training for member or parent/guardian in use of the requested stander (may be completed during a therapy session).

Submission and Documentation Requirements

Note

Documents that must be submitted before authorization

Prior to authorization, submit Arkansas DMS-679A or a dated prescription plus full device specifics, diagnosis, face-to-face evaluation with trial and dosing, and documentation of training and safe home use.

Arkansas DMS-679A (valid 6 months) or provider prescription with dated signature of an appropriately Arkansas-licensed PCP or APRN
Stander information: manufacturer, model number, type of stander, part number (if applicable), and itemized attachments/accessories with prices
Specific neuromuscular diagnosis or documented developmental delay
Face-to-face evaluation by OT/PT/RESNA-certified professional with recommendation of postural management, type of stander, goals, specific dosing, and documented trial tolerating the dose
Documentation that member or caregiver received training and demonstrated safe use of the stander in the home

Purchase and Rental Policy

Equipment	Purchase / Rental Rule	Notes / Conditions
Non-powered standing frames (prone, supine, vertical, multipositional, sit-to-stand)
Purchase
Replacement is medically necessary after 5 years when original medical necessity criteria are met and the device is out of warranty and cannot be refurbished or adequately repaired; electric/motorized/powered standing frames are excluded; items/services covered under manufacturer or dealer warranty, duplicate/conflicting DME, and replacements damaged by misuse/abuse/negligence are not covered.

Replacement Policy

inv-16: Replacement frequency — every 5 years

Replacement frequencyEvery 5 years — replacement is medically necessary after 5 years when device is out of warranty and cannot be refurbished or adequately repaired.

Required documentation at replacementDocumentation must demonstrate that original medical necessity criteria continue to be met.

ExclusionItems covered under manufacturer or dealer warranty are not eligible for replacement under this policy.

Items and Services Not Covered

Not covered under this policy are: electric, motorized, or powered standing frames. Items or services that are still under a manufacturer or dealer warranty are not reimbursable. The policy excludes DME that would duplicate or conflict with equipment already in the member’s possession, and replacement or previously approved equipment damaged by perceived misuse, abuse, or negligence. Additionally, devices are not covered when listed contraindications are present (for example, healing fracture or severe osteoporosis, significant contractures, compromised cardiopulmonary status, lack of standing tolerance, or postural hypotension).

Background and Clinical Rationale

Supported standing is intended for individuals who cannot stand independently due to neuromuscular conditions or developmental delays. The therapeutic purpose of a standing frame is to provide supported, weight‑bearing positioning to help prevent contractures and deformity and to promote therapeutic benefits such as prevention of muscle atrophy, improved circulation and strength, preservation of bone and skin integrity, improved range of motion, improved bowel and bladder function, decreased spasms, and enhanced participation in activities of daily living and psychosocial well‑being.

Definitions

inv-12: Durable Medical Equipment (DME) definition

DefinitionDurable Medical Equipment (DME) - Equipment, including repair and replacement parts, that can withstand repeated use, is primarily used to serve a medical purpose, is not useful in the absence of illness or injury, is not worn in or on the body, and is for home use.

IncludesRepair and replacement parts for the equipment.

SettingIntended for home use.

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.

ComponentsIncludes positions, equipment (such as standing frames), and prescribed physical activity.

Policy Summary

PayerCareSource

PolicyStanding Frames – Non‑powered standing frames (Arkansas)

Policy CodePolicy N/A

Change TypeAdded material requirement

Effective DateMay 1, 2026

Last ReviewFeb 11, 2026

Next Review DateN/A

SourceLink

On This Page

Training and home use:

Documentation that the member or parent/guardian received training and demonstrated safe use of the requested stander in the home setting (therapy session documentation acceptable).

Provide documentation that member or parent/guardian demonstrated safe use in the home setting (e.g., therapy session documentation of home-use trials).

Document that the device is reasonably expected to provide therapeutic benefit or enable performance of tasks otherwise not possible (examples: prevent atrophy, improve circulation/ROM, prevent ulcers, reduce swelling, improve ADLs, reduce contractures/scoliosis, etc.).

Document absence of contraindications to supported standing (examples: healing fracture/severe osteoporosis, significant contractures preventing standing, compromised cardiopulmonary status, significant inflexible skeletal deformities, lack of standing tolerance, postural hypotension).

CareSource may request proof of delivery and documentation of routine maintenance, adjustments, readjustments, or repairs.

Denial Risk

Denial Triggers and Documentation Risks

Claims or prior authorization requests may be denied if required documentation or evaluation elements are missing, if training or demonstration of safe home use is not documented, or if contraindications are present and not addressed.

Missing or incomplete Arkansas DMS-679A or provider prescription (dated signature of an appropriate Arkansas-licensed clinician).
Absent or insufficient stander details (manufacturer, model, type, part number, accessories/pricing).
No documented qualifying diagnosis (neuromuscular condition or developmental delay impairing standing).
Lack of a face-to-face evaluation by an OT, PT, or RESNA-certified professional, or evaluation missing required elements (postural management program recommendation, type of stander, goals, dosing, documented trial/tolerance).
No documentation that member or caregiver received training in the use of the requested stander.
No documentation that member or caregiver demonstrated safe use in the home setting.
Insufficient documentation that the device is expected to provide therapeutic benefit related to the member’s condition.
Presence of contraindications to supported standing without clinical justification or mitigation (e.g., unstable fracture, severe osteoporosis, significant contractures, compromised cardiopulmonary status, lack of standing tolerance, postural hypotension).
Device still under warranty, duplicated DME, or damage from misuse/abuse — these conditions may render the request non-covered.

PurposeTo maintain or improve body structures and function and increase activity and participation.