CurrentNorth Dakota Department of Health & Human ServicesPolicy N/A

Seat Lift Mechanism Coverage Criteria

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This policy governs Medicaid coverage and limitations for seat lift mechanisms prescribed for members with severe hip or knee arthritis or severe neuromuscular disease. It specifies medical-necessity criteria, documentation requirements, excluded equipment, and the replacement limit.

Policy Summary

PayerNorth Dakota Department of Health & Human Services

PolicySeat Lift Mechanism Coverage Criteria

Policy CodePolicy N/A

Change TypeRevised and clarified

Effective DateMarch 2007

Last ReviewDec 17, 2025

Next Review DateN/A

Key ActionSubmit a prescription, medical-necessity documentation, and a prescribing physician/practitioner note dated within 90 days of the requested service authorization start date.

SourceLink

POLICY UPDATE CHANGES

The documentation requirement was revised to require a prescribing physician/practitioner note within 90 days of the requested service authorization start date.

The policy was reviewed and reformatted, and CMN wording was removed from the header section.

NoService authorization required

1/5 yearsCoverage frequency limit

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CurrentNorth Dakota Department of Health & Human ServicesPolicy N/A

Seat Lift Mechanism Coverage Criteria

Customize your policy alerts

Sign up for all North Dakota Department of Health & Human Services policy alerts

Know when North Dakota Department of Health & Human Services releases new policies or updates existing guidance.

Monitor payer policy activity

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Policy Summary

PayerNorth Dakota Department of Health & Human Services

PolicySeat Lift Mechanism Coverage Criteria

Policy CodePolicy N/A

Change TypeRevised and clarified

Effective DateMarch 2007

Last ReviewDec 17, 2025

Next Review DateN/A

Key ActionSubmit a prescription, medical-necessity documentation, and a prescribing physician/practitioner note dated within 90 days of the requested service authorization start date.

SourceLink

POLICY UPDATE CHANGES

The documentation requirement was revised to require a prescribing physician/practitioner note within 90 days of the requested service authorization start date.

The policy was reviewed and reformatted, and CMN wording was removed from the header section.

NoService authorization required

1/5 yearsCoverage frequency limit

Coverage Criteria

Initial Coverage Criteria

Coverage is allowed when ALL of the following conditions are met:

ALL of the following

The member has severe arthritis of the hip or knee, or has a severe neuromuscular disease.
The seat lift mechanism is part of the physician's or practitioner's course of treatment and is prescribed to effect improvement in, or arrest or retard deterioration of, the member's condition.
The member is completely incapable of standing up from a regular armchair or any chair in their home. Difficulty or inability to get up from a chair, particularly a low chair, is not sufficient justification when the member can ambulate and the chair has an appropriate seat height and arms.
Once standing, the member is able to ambulate.
The seat lift mechanism operates smoothly, can be controlled by the member, and effectively assists the member in standing up and sitting down without other assistance.
All other therapeutic modalities, including medication and physical therapy, have been tried and failed.
Coverage is limited to one seat lift mechanism every five years.1 every 5 years

Excluded from coverage is a seat lift mechanism that operates via a spring-release mechanism with a sudden, catapult-like motion that jolts the member from a seated to a standing position.

A seat lift mechanism (E0172) placed over or on top of a toilet, of any type, is non-covered.

Coding and Non-Covered Codes

Not CoveredHCPCSNot Covered

E0172

Seat lift mechanism placed over or on top of a toilet, any type

Provider Actions and Denial Risks

Step Therapy

Failed Conservative Treatment

Before coverage is considered, all other therapeutic modalities must have been tried and failed. This includes medication and physical therapy.

Documentation Required

Required Clinical Documentation

The provider submission must include the required prescription and supporting clinical documentation. The prescribing physician or practitioner must also provide a note within 90 days of the requested service-authorization start date.

A prescription from a prescribing physician/practitioner.
Medical documentation supporting the need.
A prescribing physician/practitioner note within 90 days of the service authorization's requested start date.

Background

A seat lift mechanism assists the member with transitioning from sitting to standing and returning to a seated position. Covered mechanisms must operate smoothly, be controlled by the member, and assist the member in standing and sitting without assistance from another person.

Covered Equipment Definition

Covered seat lift mechanism

OperationOperates smoothly

ControlCan be controlled by the member

Standing assistanceEffectively assists the member in standing up without assistance from another person

Sitting assistanceEffectively assists the member in sitting down without assistance from another person

Medical Necessity

Medical Necessity Criteria

Medical necessity is established only when all of the following conditions are met:

All medical-necessity conditions

ALL of the following
- The member has severe arthritis of the hip or knee or severe neuromuscular disease.
- The seat lift mechanism is part of the physician/practitioner's course of treatment and is prescribed to improve, arrest, or retard deterioration in the member's condition.
- The member is completely incapable of standing up from a regular armchair or any chair in the home.
  Difficulty rising from a low chair, or inability to rise from an unsuitable chair alone, is not sufficient justification.

Replacement Limit

Seat lift mechanism replacement

EquipmentSeat lift mechanism

Coverage limitLimited to one seat lift mechanism during the interval

Replacement intervalEvery five years

Documentation Requirements

Documentation Required

Support the equipment need

Provide medical documentation that supports the member’s need for the equipment.

Documentation Required

Obtain the required prescription

The prescription must be issued by the prescribing physician/practitioner.

Documentation Required

Meet the 90-day note requirement

Submit a prescribing physician/practitioner note dated within 90 days of the service authorization’s requested start date.

Non-Covered Equipment

Not covered: seat lift mechanisms using a spring-release mechanism with a sudden, catapult-like motion that jolts the member from seated to standing; and E0172 seat lift mechanisms placed over or on top of a toilet, of any type.