Premera Bluecross Patient Lifts Coverage Update

Coverage Criteria for Patient Lifts, Seat Lifts, and Standing Devices

Non-electric patient lifts (E0630)

Covered when ALL of the following are met:

Non-electric patient lifts (E0630): (1) Transferring the individual between the bed and a chair, wheelchair, or commode requires the assistance of more than one individual; AND (2) The individual has a medical condition that, without the use of a patient lift, the individual would be bed-confined; AND (3) An adequately trained individual, other than the patient, is available to help operate the lift; AND (4) A canvas or nylon sling or seat (E0621) is ordered as a replacement accessory for an approved lift.

Multi-positional transfer systems

Covered when ALL of the following are met:

Multi-positional transfer system (E1035, E1036): All criteria for non-electric/hydraulic patient lifts are met (see Non-electric patient lifts), AND the individual requires supine positioning for transfers.

Codes E1035/E1036 carry weight-capacity distinctions as documented in coding.

Weight capacity (coding note): E1035: patient weight capacity up to and including 300 lbs; E1036: patient weight capacity greater than 300 lbs.

From coding/threshold guidance.

Non-electric seat lift mechanisms (E0629)

Covered when ALL of the following are met:

Non-electric seat lift mechanism (E0629): (1) The individual has severe arthritis of the hip or knee or has a severe neuromuscular disease; AND (2) The seat lift mechanism is prescribed to improve health status or arrest or retard deterioration in the individual's condition; AND (3) The individual is incapable of standing up from any chair in their home; AND (4) The individual has the ability to ambulate once standing.

Spring-release seat lift devices are considered not medically necessary per policy.

Standing devices

Covered when ALL of the following are met:

Standing devices (E0638, E0641, E0642): (1) The individual is unable to ambulate or stand independently because of a neuromuscular condition but has sufficient residual strength in the lower extremities to allow use of the device; AND (2) A standing position cannot be successfully achieved even with the use of physical therapy or other assistive devices; AND (3) The individual has completed appropriate standing device training and has demonstrated an ability to safely use the device; AND (4) Use of the device is expected to allow meaningful improvement in at least one of the following: functional use of arms or hands; functional head and trunk control; performance of activities of daily living (ADLs); digestive, respiratory, circulatory, or excretory function; or skin integrity by off-loading weight through standing.

Documentation must show completion of training and demonstrated safe use.

Electric/powered lifts

Electric/powered lifts: Electric lift mechanisms and electric/powered seat lift chairs are considered convenience items and are not payable; payment is limited to non-electric mechanical seat-lift mechanisms alone even if incorporated into a chair; chairs are considered furniture and not DME.

Electric lifts are contractual exclusions per policy.

Standing / lift-to-seat medical necessity

Covered when ALL of the following are met:

Functional benefit: Use of the device is expected to allow meaningful improvement in at least one specified functional domain: functional use of arms or hands; functional head and trunk control; performance of activities of daily living; digestive, respiratory, circulatory, or excretory function; or skin integrity by off-loading weight through standing.

From policy medical necessity statements added to standing device criteria.

Operator availability: An adequately trained individual, other than the patient, is available to help operate the lift-to-seat device.

Operational clarification added to medical necessity criteria.

The policy excludes items considered home or vehicle modifications and convenience items. Specifically, bathroom/toilet/tub lifts (e.g., E0170, E0171, E0172, E0625) and devices that are fixtures to real property (such as stairway chair/stair lifts, stair gliders, platform lifts, van/vehicle lifts, and other structural home or vehicle modifications) are not covered. Ceiling lifts that are fixed or motorized and permanent ceiling- or wall-mounted systems are treated as home modifications and are not payable under this policy. Combination powered sit-to-stand systems and other powered/ motorized lift mechanisms incorporated into furniture or fixed installations are also excluded as convenience items.

Certain HCPCS/CPT codes related to lift and seat-lift technologies have been moved or are addressed in other policies. Notably, E0640 was added to coding, and codes E0635, E0636, and E0640 may be addressed in a separate policy. Providers should follow cross-policy guidance for those codes when submitting claims.

The policy considers some device types not medically necessary or contract exclusions. Spring-release seat lift devices and powered or combination sit-to-stand devices (motorized sit-to-stand systems) are treated as convenience items and are not medically necessary/not payable. Coverage is limited to non-electric, mechanical seat-lift mechanisms where criteria are met; chairs and powered sit-to-stand combinations are considered furniture or convenience items and do not meet DME criteria.

Codes that have been reassigned to the Non-Covered section should be billed as non-covered under this policy. In particular, E0171 and E0625 have been moved to the Non-Covered coding section and are considered non-covered when billed under this policy.

HCPCS/CPT Coding and Code Status

HCPCS codes referencedHCPCS

E0621	Sling or seat; patient lift; canvas or nylon.
E0627	Seat lift mechanism, electric (description noted elsewhere in history/notes).
E0629	Seat lift mechanism, nonelectric; any type
E0630	Patient lift; (description in document)
E0637	Combination sit-to-stand frame/table system, any size including pediatric, with seat lift feature; with or without wheels.
E0638	Standing frame system, one position upright; (supine or prone stander), any size including pediatric, with or without wheels.
E0639	Patient lift; moveable from room to room with disassembly and reassembly, includes all components/accessories.
E0635	Electric patient lift mechanism (document states electric lifts as convenience items).
E0641	Standing frame system, multi-position (three-way stander), any size including pediatric; with or without wheels.
E0642	Standing frame/table system; mobile (dynamic stander), any size including pediatric.

1–10 of 17

1/2

Coding changes and cross-policy addressesHCPCS

E0640	HCPCS code added (standing/seat lift related)
E0171	HCPCS code moved to Non-Covered
E0625	HCPCS code moved to Non-Covered
E0635	CPT/HCPCS addressed in separate policy
E0636	CPT/HCPCS addressed in separate policy
E0985	HCPCS removed from related wheelchair policy
E2300	HCPCS related wheelchair seat lift mechanism referenced as addressed in another policy

Weight capacity threshold

E1035 weight capacityUp to and including 300 lbs

E1036 weight capacityGreater than 300 lbs

Code descriptions sourceHCPCS descriptions as listed in policy coding section

Additional coding

Placeholder code entryNo additional coding detail provided in brief/source for this inventory item

ActionRefer to HCPCS coding table in policy for complete code descriptions

Notes

Medical Necessity Requirements

General DME medical necessity

Coverage requires meeting device-specific clinical criteria and DME eligibility:

General DME medical necessity: Equipment must meet the definition of DME, be movable (not permanently attached), used in an appropriate room (patient lifts are used in a room other than the bathroom), and meet the specific clinical criteria for the device type (see device-specific criteria for lifts, multi-positional systems, seat lift mechanisms, and standing devices).

See individual device criteria for required elements such as training, operator availability, and clinical indications.

DME-specific medical necessity

Medical necessity requires both functional benefit and operator availability:

Functional benefit requirement: Device use is expected to provide meaningful improvement in at least one specified functional domain (arms/hands, head/trunk control, ADLs, digestive/respiratory/circulatory/excretory function, or skin integrity).

As specified in standing device medical necessity statements.

Provider Actions, Prior Authorization, and Denial Risks

Prior Authorization

Prior authorization / medical necessity

Devices are subject to medical necessity review and prior authorization as applicable. Prior authorization may be required before services are rendered; verify the member’s plan requirements.

Prior authorization may be required for durable medical equipment (DME) including lifts, seat-lift mechanisms, standing devices, and multi-positional systems.

Note

Verify benefits and authorization

Verify member benefits and prior authorization requirements with the payer before ordering or billing. Coverage is plan-dependent and limits or exclusions may apply.

Consult the member benefit booklet or contact Premera customer service to confirm coverage, plan-specific limits, and prior authorization requirements.
If benefits are not verified and a non-covered item is provided, the claim may be denied and patient may be liable for charges.

Definitions

Patient Lifts — definition and scope

DefinitionMechanical or electric devices that assist a caregiver in transferring an individual who is immobilized between a bed and a chair; includes multi-positional transfer systems used when supine positioning is required

ScopeIncludes moveable lifts (E0630, E0639) and multi-positional systems (E1035, E1036) used in rooms other than the bathroom

Exclusion noteFixed motorized ceiling/wall-mounted systems and bathroom/toilet/tub lifts are considered convenience items or home modifications and are not covered

Seat lift mechanisms and Standing Devices — definitions

Seat lift mechanismsDevices (mechanical or electric) that assist an individual to stand up from sitting without other assistance; may be separate mechanisms placed under a chair or incorporated into furniture

Standing devices (standers)

Required Documentation and Evidence

Documentation Required

Clinical documentation supporting medical necessity and functional benefit

Medical records must include office visit notes with relevant history and physical that support the need for the requested equipment; for standing devices, include documentation of training completion and demonstrated safe use.

Office visit notes detailing history, physical exam, and how device criteria are met.
Standing-device-specific training completion and observed safe use documented in the record.

Step Therapy

Benefit verification and prior authorization as applicable

Verify member benefits and plan limits and obtain prior authorization as applicable; consult the member benefit booklet or contact customer service to confirm coverage details.

Confirm whether the DME benefit applies and whether prior authorization is required for the specific HCPCS code.
Benefit applicability can vary by contract; this policy does not apply to Medicare Advantage.

Rental and Purchase Rules

Item / HCPCS code	Rental vs Purchase rule	Notes
Patient lifts (E0630, E0639)
Purchase (DME benefit — refer to member benefit booklet). Patient lifts are durable medical equipment; coverage is subject to member benefit limits and must meet medical necessity criteria.
Patient lifts must be movable (not permanently attached) and used in a room other than the bathroom to be eligible; verify member benefits for any rental vs purchase limitations.
Multi-positional transfer systems (E1035, E1036)
Purchase (DME benefit — refer to member benefit booklet).
Codes E1035/E1036 include weight-capacity distinctions; coverage requires meeting transfer-system medical necessity (including supine positioning).
Non-electric seat lift mechanisms (E0629)
Purchase (DME benefit — refer to member benefit booklet).
Payment limited to non-electric mechanical seat-lift mechanisms; spring-release devices considered not medically necessary.
Standing devices / standers (E0638, E0641, E0642)
Purchase (DME benefit — refer to member benefit booklet).
Coverage requires documented training, demonstrated safe use, and expectation of meaningful functional improvement; verify benefits and prior authorization as applicable.
Electric/powered lift mechanisms and powered lift chairs (E0635, E0636, others)
Not covered / Contract exclusion (chairs considered furniture).
Electric lift mechanisms and powered lift chairs are convenience items and are not payable under this DME policy; payment limited to non-electric mechanisms if appropriate.
Ceiling lifts, bathroom/toilet/tub lifts, vehicle/structural lifts (E0640, E0170-E0172, E0625)
Not covered / Contract exclusion.
Ceiling-mounted or fixed motorized lifts and bathroom/vehicle modifications are considered home/vehicle modifications and are excluded from coverage.

HCPCS code(s)	Policy / Coding action	Cross-reference / Notes
E0640
Added to coding history and referenced as ceiling lift (addressed in document history).
Ceiling lifts are generally excluded when fixed/motorized; see exclusions and confirm other policy references.
E0171, E0625
Moved to Non-Covered coding section (Non-Covered / contract exclusion).
Bathroom/toilet/tub lift codes designated Non-Covered when billed under this policy; risk of denial if submitted here.
E0635, E0636
Addressed in a separate policy (refer to cross-policy guidance).
Electric patient lift mechanisms / powered seat-lift chairs
Considered convenience items / contractual exclusions and not payable under this DME policy; related codes may be handled in other policies.
E0985, E2300
Referenced in history as removed from related wheelchair policy (cross-policy coding adjustments).
E1035, E1036
Retained in coverage coding for multi-positional transfer systems with weight-capacity distinctions (E1035 ≤300 lb; E1036 >300 lb).
Weight-capacity threshold: E1035 up to and including 300 lbs; E1036 greater than 300 lbs.

Replacement

Replacement rules / key values

Replacement policy detailsNo specific replacement intervals or rules specified in policy text for these inventory items

DocumentationRefer to billing/rental rules and related policies for any equipment-specific replacement guidance

Coding/history notePolicy history includes coding changes and cross-policy references; check related policies for seat lift mechanisms addressed elsewhere (e.g., wheelchair policies)

Services and Items Not Covered

Summary of not-covered items: Electric/powered lift mechanisms and powered lift chairs are considered convenience items and are not covered. Ceiling lifts that are fixed or motorized, and other fixed motorized ceiling/wall-mounted systems, are treated as home modifications and are not covered. Structural home or vehicle modifications—including stair lifts, platform lifts, van/vehicle lifts, vehicle ramps, and other built-in or permanently attached lift systems—are excluded as home/vehicle modifications and are not payable under this policy.

Requests for items that fall within these exclusions will typically be denied because they are considered structural modifications or convenience items. Examples include bathroom/toilet/tub lifts, fixed ceiling track systems, and vehicle/van lifts. Ceiling lifts and related track systems are frequently motorized and, when fixed to the home, are treated as residential modifications rather than DME.

Ceiling-mounted and permanently affixed lift systems allow transfers between rooms but when the lift is fixed or motorized it constitutes a home modification and is excluded from coverage. Similarly, equipment intended primarily to modify the home or vehicle (for example, stairway chair lifts or platform lifts) does not meet the DME definition and is not covered.

Powered combination sit-to-stand systems and chairs with integrated powered lift mechanisms are considered convenience items. Coverage is limited to non-electric mechanical seat-lift mechanisms when criteria are met; powered or motorized chairs and combination devices are not payable.

Administrative coding update: HCPCS codes E0171 and E0625 have been moved to the Non-Covered coding section and are considered non-covered when billed under this policy. Providers should not submit these codes for coverage under this policy.

Background

Background: Patient lifts and standing devices support safe transfers and upright positioning. Patient lifts are mechanical or electric devices used by caregivers to transfer individuals who are immobilized between bed and chair or commode and may include slings or integrated seats. Standing devices (standers) provide supported upright positioning for individuals with sufficient residual lower-extremity strength and are intended to improve functional outcomes such as ADLs, head and trunk control, organ system function, and skin integrity. The policy distinguishes movable, non-fixed equipment that may meet DME criteria from fixed ceiling- or wall-mounted systems and home or vehicle modifications, which are not covered.

Revision History

2019-05-10coding update

Added HCPCS code E0172 and noted CPT code E0640; CPT codes E0171 and E0625 moved to the Non-Covered coding section; coding updates reflected.

2020-03-10administrative deletion

Policy approved for deletion effective July 2, 2020 and to be replaced with InterQual criteria for dates of service on or after July 2, 2020.

2020-07-02deletion effective date

OpenPayer

Patient Lifts, Seat Lifts and Standing Devices

Coverage Criteria for Patient Lifts, Seat Lifts, and Standing Devices

HCPCS/CPT Coding and Code Status

Medical Necessity Requirements

Provider Actions, Prior Authorization, and Denial Risks

Definitions

Required Documentation and Evidence

Rental and Purchase Rules

Replacement

Services and Items Not Covered

Background

Revision History