A seat lift mechanism is used to allow a person to move from a seated position to a standing position. A patient lift is used to transfer the person from one surface to another.
The following providers may provide patient lifts and seat lift mechanisms:
• Medical suppliers
• Home health agencies
• Indian Health Services
• Federally Qualified Health Centers
• Rural Health Clinics
Providers must meet any provider criteria, including accreditation, for third party insurance or for Medicare in order to assist recipients for whom MHCP is not the primary payer.
MHCP quantity limits and thresholds apply to all recipients unless only Medicare co-insurance or deductible is requested.
Patient lifts and seat lift mechanisms are covered for all eligible MHCP recipients who meet coverage criteria. Recipients in nursing facilities and intermediate care facilities for persons with developmental disabilities are not eligible for patient lifts or seat lift mechanisms.
Codes: E0621: Sling or seat, patient lift, canvas or nylon. E0630, E0635, E0636, E0639: patient lifts. E0627, E0629: seat lift mechanisms.
Hydraulic or mechanical patient lifts described by E0630 are covered for recipients who meet the following criteria:
• The recipient requires help from another person to transfer between a wheelchair, bed, commode, or other surfaces in the home
• The recipient cannot be safely transferred without a lift due to the recipient’s medical condition or the caregiver’s limitations
• The lift is documented as fitting in all necessary parts of the recipient’s home
Multi-positional patient support systems with integrated lift described by E0636, and moveable patient lifts described by E0639 are covered for recipients who meet criteria for a patient lift and whose unique medical needs cannot be met with a less costly lift.
Electric patient lifts described by E0635 are covered for recipients who meet criteria for a hydraulic or mechanical lift and who meet one of the following criteria:
• The recipient has a medical condition that prevents safe transfer using a hydraulic or mechanical lift
• The primary caretaker is unable to operate a hydraulic or mechanical lift but can operate an electric lift and can perform all necessary cares
Seat lift mechanisms are covered for recipients who meet all of the following criteria:
• The recipient has arthritis of the hip or knee, neuromuscular disease or another medical condition that affects his or her strength or mobility
• The recipient is unable to stand up from a regular armchair at home
• Once standing, the recipient has the ability to ambulate independently or with a properly fitted walker or cane
Non-electric seat lift mechanisms that operate by spring release mechanism are not covered because they are not the community standard of care and pose a risk to recipients with limited strength.
Although a seat lift mechanism may be covered, the chair for which the mechanism is intended is not covered because it is furniture rather than medical equipment.
• The following items are not covered because they are home or vehicle modifications, not durable medical equipment:
• Vehicle lifts
• Platform lifts
• Stair lifts
• Wheelchair lifts
• Non-portable ramps
• Ceiling lifts
• Wall mounted lifts
Authorization is required for the following:
• Any rental or purchase of multipositional patient support systems (E0636), moveable patient lifts (E0639), and seat lift mechanisms (E0627, E0629)
• Any rental or purchase of a patient lift when the patient’s current lift, regardless of lift type, is less than five years old
Refer to Non-Mobility Equipment Repairs for authorization requirements for repairs to lift equipment.
Authorization is not required for hydraulic or mechanical, or electric lifts except as described above. If requesting authorization for an electric or a hydraulic or mechanical lift, clearly state on the authorization request the reason authorization is requested (repair over $400 or replacement within five years).
For all requests for patient lifts, documentation must include the following:
• Recipient weight and height, and general strength and age of primary caretaker
• Documentation of the medical condition that requires the specific kind of lift requested
• Description of the current method of transfer and why it does not meet the recipient’s needs
• Description of how the lift will be used in critical areas of the residence
• The plan of care
• Documentation of satisfactory recipient and caretaker use of the lift
• Documentation that the lift will fit in all necessary areas of the home
• Less costly alternatives considered and why they were rejected
Submit authorization requests with required documentation to the authorization medical review agent.
Refer to the following billing requirements:
• Effective for dates of service July 1, 2015, and after, electric patient lifts (E0635) will be priced by report. Discontinue use of modifier U3 for higher reimbursement. Attach pricing documentation with claim submission.
• All hydraulic, mechanical, or electric lifts include a seat or sling with initial dispensing. Do not bill separately.
• Use X12 Batch or MN–ITS 837P Professional electronic claim.
• Report the ordering provider in the Other Provider Types section of the MN–ITS Interactive claim.
• If the recipient has Medicare, MHCP will pay only the deductible and coinsurance on any item for which Medicare made payment, regardless of any MHCP prior authorization.
• If the recipient has Medicare, any items for which Medicare denies payment must meet MHCP coverage and authorization requirements.
• Shipping and delivery costs are included in the MHCP maximum allowable payment and may not be billed separately to MHCP or the recipient.
• Patient lifts and seat lift mechanisms are expected to serve the recipient for at least five years. If a device is stolen or damaged beyond repair, a replacement device may be covered with authorization. Equipment should not be replaced if it is still usable and meets the patient’s needs after five years.
• For repair of seat lift mechanisms which were originally dispensed as E0628, providers may use E0627 or E0629 with modifier RB as appropriate, and enter the HCPCS code under which the item was originally dispensed in the notes field.
• Refer to Non-Mobility Equipment Repairs for additional billing requirements for repairs to lift equipment.
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