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Phone: ...919.876.4336
.....Fax: .......919.876.4485
.....Address: 3430 Tarheel Drive,
...................Suite 104
...................Raleigh, NC 27609


 
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LIFTS AND SLINGS
PATIENT LIFTS
Indications and Limitations of Coverage and/or Medical Necessity
Documentation Requirements
SEAT LIFT MECHANISMS
Indications and Limitations of Coverage and/or Medical Necessity
Documentation Requirements

 

PATIENT LIFTS

Indications and Limitations of Coverage and/or Medical Necessity

A lift, Code E0630, is covered if transfer between bed and a chair, wheelchair, or commode requires the assistance of more than one person and, without the use of a lift, the patient would be bed confined.

An electric lift mechanism is not covered; it is a convenience feature.

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Documentation Requirements

An order for each item billed must be signed and dated by the treating physician, kept on file by the supplier, and made available to the DMERC upon request.

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SEAT LIFT MECHANISMS

Indications and Limitations of Coverage and/or Medical Necessity

A seat lift mechanism is covered if all of the following criteria are met:

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

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.

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. Almost all patients who are capable of ambulating can get out of an ordinary chair if the seat height is appropriate and the chair has arms.)

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

Coverage is limited to the seat lift mechanism, even if it is incorporated into a chair (E0627).

The physician ordering the lift mechanism must be the treating physician or a consulting physician for the disease or condition resulting in the need for a seat lift. The physician's record must document that all appropriate therapeutic modalities (e.g., medication, physical therapy) have been tried and failed to enable the patient to transfer from a chair to a standing position.

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Documentation Requirements

An order for each item billed must be signed and dated by the treating physician, kept on file by the supplier, and made available to the DMERC upon request.

A Certificate of Medical Necessity (CMN), which has been completed, signed, and dated by the treating physician, must be kept on file by the supplier and made available to the DMERC on request. The CMN may act as a substitute for a written order if it contains all of the required elements of an order. The CMN for seat lift mechanism is HCFA form 849. The initial claim must include a copy of the CMN.

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