Seat Lift Mechanism

Lift chairs are chairs that feature a powered lifting mechanism that pushes the entire chair up from its base, allowing the user to easily move to a standing position. Only the lifting mechanism is covered by Medicare. This means that the patient will ALWAYS be responsible for a portion of the bill related to the chair itself.

HCPCS Code:

E0627 – mechanism incorporated into purchased chair
E0628 – mechanism installed into patient owned furniture

Category:

Purchase – pays for the mechanism only

Common Diagnosis:

(check for current coding)

714.xx - 715.xx Arthritis or
Neuromuscular diseases

Coverage Information

Requires a CMN, and Written Order Prior to Delivery (WOPD)

WOPD is detailed written order that is signed AND dated by the physician. It MUST be in hand, dated prior to the delivery date of the item (same day or before). It is recommended that you obtain a completed CMN prior to delivery. If you follow that process the CMN can also serve as the WOPD. Covered if the following criteria are met:

1. The patient must have severe arthritis of the hip or knee or have a severe neuromuscular disease; AND

2. The seat lift mechanism must be a part of the physician's course of treatment and be prescribed to effect improvement, or arrest or retard deterioration in the patient's condition; AND

3. The patient must be completely incapable of standing up from a regular armchair or any chair in their home. (The fact that a patient has difficulty or is even incapable of getting up from a chair, particularly a low chair, is not sufficient justification for a seat lift mechanism.) Most patients who are capable of ambulating can get out of an ordinary chair (if the seat height is appropriate and the chair has arms), which is why this item is a difficult one for which to qualify a Medicare patient. AND

4. Once standing, the patient must have the ability to ambulate.

Note 1: Do not deliver until CMN is returned.

Note 2: Use Advanced Beneficiary Notice (ABN) if coverage criteria are not met and patient still wants seat lift mechanism. This documents that the patient was informed of non-coverage prior to accepting delivery of the item.

Note 3: Use EY modifier if Medicare beneficiary wishes to purchase without a CMN, but wants you to bill Medicare “to see if they will pay” – they will not. EY tells MC you have no physician order.

Documentation Requirements: in addition to the basic Medicare documentation (proof of delivery, AOB, etc.)

1. Written Order Prior to Delivery (WOPD): You may use the CMN that is also required to fulfill this requirement if the CMN is signed and dated by the physician prior to the date of delivery of the item, as noted on your delivery ticket, signed and dated by the patient / caregiver.

2. Optional, but strongly recommended: Physician notes that document that the seat lift mechanism is "part of the physician's course of treatment and be prescribed to effect improvement, or arrest or retard deterioration in the patient's condition."

3. Certificate of Medical Necessity (CMN) - Seat Lift Mechanism: The Medicare designated CMN form for a seat lift mechanism must be obtained. The questions may only be answered by the physician or his/her staff members, and must be signed and dated by the physician before a claim can be filed.

Explanation of CMN Questions / Answers:

1 or 2 = At least one must be YES
3 = Must be YES
4 = Must be YES
5 = Must be YES

1) Patient must have either severe arthritis of the hip or knee, or have a severe neuromuscular disease. This would make either question # 1 or # 2 = YES

2) Patient must be completely incapable of standing up from a regular armchair or ANY chair in his/her home. Difficulty getting up from a chair is not sufficient for coverage. This would make question # 3 = YES

3) Once standing the patient must have the ability to ambulate. This would make question # 4 = YES

4) All appropriate therapeutic modalities to enable the patient to transfer from chair to a standing position must have been tried and failed. This must be documented in the patient’s medical record. This would make question # 5 = YES