LCD for Patient Lifts (L5064)

 

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Contractor Information

Contractor Name 

NHIC 

Contractor Number 

16003 

Contractor Type 

DME MAC 

 

LCD Information

LCD ID Number 

L5064 

 

LCD Title 

Patient Lifts 

 

Contractor's Determination Number 

PTLT20080101 

 

AMA CPT / ADA CDT Copyright Statement 

CPT codes, descriptions and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.  

 

CMS National Coverage Policy 

CMS Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, Section 280.1 

 

Primary Geographic Jurisdiction 

Connecticut
District of Columbia
Delaware
Massachusetts
Maryland
Maine
New Hampshire
New Jersey
New York - Entire State
Pennsylvania
Rhode Island
Vermont
 

 

Oversight Region 

Region III
 

 

 

DME Region LCD Covers 

Jurisdiction A 

 

Original Determination Effective Date 

For services performed on or after 10/01/1993  

 

Original Determination Ending Date 

 

 

Revision Effective Date 

For services performed on or after 01/01/2008  

 

Revision Ending Date 

 

 

Indications and Limitations of Coverage and/or Medical Necessity 

For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements. For the items addressed in this medical policy, the criteria for "reasonable and necessary" are defined by the following indications and limitations of coverage and/or medical necessity.

For an item to be covered by Medicare, a written signed and dated order must be received by the supplier before a claim is submitted. If the supplier bills for an item addressed in this policy without first receiving the completed order, the item will be denied as not medically necessary.

A lift, (E0630,E0635,E0636) 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. When code E0635 or E0636 is billed, if coverage criteria for a patient lift are met, payment is based on the least costly medically appropriate alternative, E0630.

Code E0621 is covered as an accessory when ordered as a replacement for the original equipment item.

A multi-positional patient transfer system (E1035) is covered if both of the following criteria 1 and 2 are met:

 

  1. The criteria for a lift (E0630) are met; and
  2. The patient requires supine positioning for transfers.



If criterion 1 is not met, code E1035 will be denied as not medically necessary.

If criterion 1 is met but criterion 2 is not met, payment will be made for the least costly medically appropriate alternative, E0630.

If coverage is provided for code E1035, payment will be discontinued for any other mobility assistive equipment, including but not limited to: canes, crutches, walkers, rollabout chairs, transfer chairs, manual wheelchairs, power-operated vehicles, or power wheelchairs.
 

 

Coverage Topic 

Durable Medical Equipment
 

 

Coding Information

CPT/HCPCS Codes 

The appearance of a code in this section does not necessarily indicate coverage.

HCPCS MODIFIER:

EY – No physician or other licensed health care provider order for this item or service

HCPCS CODES:

E0621

SLING OR SEAT, PATIENT LIFT, CANVAS OR NYLON

E0625

PATIENT LIFT, BATHROOM OR TOILET, NOT OTHERWISE CLASSIFIED

E0630

PATIENT LIFT, HYDRAULIC OR MECHANICAL, INCLUDES ANY SEAT, SLING, STRAP(S) OR PAD(S)

E0635

PATIENT LIFT, ELECTRIC WITH SEAT OR SLING

E0636

MULTIPOSITIONAL PATIENT SUPPORT SYSTEM, WITH INTEGRATED LIFT, PATIENT ACCESSIBLE CONTROLS

E0639

PATIENT LIFT, MOVEABLE FROM ROOM TO ROOM WITH DISASSEMBLY AND REASSEMBLY, INCLUDES ALL COMPONENTS/ACCESSORIES

E0640

PATIENT LIFT, FIXED SYSTEM, INCLUDES ALL COMPONENTS/ACCESSORIES

E1035

MULTI-POSITIONAL PATIENT TRANSFER SYSTEM, WITH INTEGRATED SEAT, OPERATED BY CARE GIVER

 

 

ICD-9 Codes that Support Medical Necessity 

Not specified.

 

 

 

Diagnoses that Support Medical Necessity 

Not specified.
 

 

ICD-9 Codes that DO NOT Support Medical Necessity 

Not specified.

 

 

 

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation 

 

 

Diagnoses that DO NOT Support Medical Necessity 

Not specified. 

 

General Information

Documentation Requirements 

Section 1833(e) of the Social Security Act precludes payment to any provider of services unless "there has been furnished such information as may be necessary in order to determine the amounts due such provider." It is expected that the patient's medical records will reflect the need for the care provided. The patient's medical records include the physician's office records, hospital records, nursing home records, home health agency records, records from other healthcare professionals and test reports. This documentation must be available upon request.

An order for each item billed must be signed and dated by the treating physician, kept on file by the supplier, and made available upon request. Items billed before a signed and dated order has been received by the supplier must be submitted with an EY modifier added to each affected HCPCS code.

For E1035, suppliers must add a KX modifier to a code only if all of the criteria in the “Indications and Limitations of Coverage and/or Medical Necessity” sections of this LCD have been met. If the requirements for the KX modifier are not met, the KX modifier must not be used.

The patient’s medical record must contain information demonstrating that all of the applicable coverage criteria are met. This information must be available upon request.

When an upgrade is provided, the GA, GK, GL, and/or GZ modifiers must be used to indicate the upgrade.

Refer to the Supplier Manual for more information on documentation requirements. 

 

Appendices 

 

 

Utilization Guidelines 

Refer to Indications and Limitations of Coverage and/or Medical Necessity. 

 

Sources of Information and Basis for Decision 

Reserved for future use. 

 

Advisory Committee Meeting Notes 

 

 

Start Date of Comment Period 

03/30/1993 

 

End Date of Comment Period 

05/14/1993 

 

Start Date of Notice Period 

08/01/1993 

 

Revision History Number 

PTLT005 

 

Revision History Explanation 

3/1/2008- In accordance with Section 911 of the Medicare Modernization Act, this policy was transitioned to DME MAC NHIC (16003) LCD L5064 from DME PSC TriCenturion (77011) LCD L5064.

Revision Effective Date: 01/01/2008
INDICATIONS AND LIMITATIONS OF COVERAGE:
Added E1035
HCPCS CODES AND MODIFIERS:
Added E1035
Revised E0630
DOCUMENTATION REQUIREMENTS:
Added KX modifier instructions.
Added Upgrade instructions

11/10/2007 - The description for CPT/HCPCS code E0630 was changed in group 1

Revision Effective Date: 07/01/2007
INDICATIONS AND LIMITATIONS OF COVERAGE:
Removed DMERC references
DOCUMENTATION REQUIREMENTS:
Removed DMERC references

06/01/2007 - In accordance with Section 911 of the Medicare Modernization Act of 2003, Virginia and West Virginia were transitioned from DME PSC TriCenturion (77011) to DME PSC TrustSolutions (77012).

03/01/2006 - In accordance with Section 911 of the Medicare Modernization Act of 2003, this policy was transitioned to DME PSC TriCenturion (77011) from DMERC Tricenturion (77011).

Revision effective date: 01/01/2005
LMRP converted to LCD and Policy Article
HCPCS CODES AND MODIFIERS:
Added E0639, E0640

Revision effective date: 04/01/2003
HCPCS CODES AND MODIFIERS:
Added: EY modifier, Added HCPCS code E0636
INDICATIONS AND LIMITATIONS OF COVERAGE:
Adds standard language concerning coverage of items without an order. Added least costly alternative language for E0636.
DOCUMENTATION REQUIREMENTS:
Adds standard language concerning use of EY modifier for items without an order.


 

 

Last Reviewed On Date 

 

 

Related Documents 

Article(s)
A23657 - Patient Lifts - Policy Article - Effective January 2008

 

LCD Attachments 

There are no attachments for this LCD

 

 

Article for Patient Lifts - Policy Article - Effective January 2008 (A23657)

 

Top of Form

Bottom of Form

 

Contractor Information

Contractor Name 

NHIC 

Contractor Number 

16003 

Contractor Type 

DME MAC 

 

Article Information

Article ID Number 

A23657 

Article Type 

Article

Key Article 

Yes

Article Title 

Patient Lifts - Policy Article - Effective January 2008 

 

Primary Geographic Jurisdiction 

Connecticut
District of Columbia
Delaware
Massachusetts
Maryland
Maine
New Hampshire
New Jersey
New York - Entire State
Pennsylvania
Rhode Island
Vermont
 

DME Region Article Covers 

Jurisdiction A 

Original Article Effective Date 

01/01/2005

Article Revision Effective Date 

01/01/2008

Article Text 

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

E0625 is non-covered as a convenience item; not primarily medical in nature.

E0639 and E0640 are non-covered. These items do not meet the statutory definition of durable medical equipment.

Coding Guidelines

Heavy duty and bariatric lifts are included in the codes for patient lifts, E0630 – E0640.

A patient lift for a toilet/tub, any type (E0625) describes a device with which the patient can be transferred from the toilet/tub to another seat (e.g., wheelchair). It is used for a patient who is unable to ambulate. Devices included in this code may be attached to the toilet, ceiling, floor, or wall of the bathroom or may be freestanding. Some items may be placed in a tub for lifting the patient in and out of the tub but may not necessarily be attached to the toilet, ceiling, floor, or wall of the bathroom.

A multi-positional patient transfer system, with integrated seat, operated by caregiver (E1035) describes a device that can be positioned and adjusted such that the bed-bound patient can be transferred onto the device in the supine position. Once positioned on the device, it can then be adjusted to a chair-like position with multiple degrees of recline and leg elevation. It has small, castor wheels that are not accessible by the patient for mobility.

A Column II code is included in the allowance for the corresponding Column I code when provided at the same time.

Column I
(Column II)
E0625
(E0621)
E0630
(E0621)
E0635
(E0621)
E0636
(E0621)

Suppliers should contact the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC) for guidance on the correct coding of these items.

Coverage Topic 

Durable Medical Equipment
 

 

Coding Information

No Coding Information has been entered in this section of the article.

 

Other Information

Revision History Explanation 

3/1/2008- In accordance with Section 911 of the Medicare Modernization Act, this policy was transitioned to DME MAC NHIC (16003) Article A23657 from DME PSC TriCenturion (77011) Article A23657.

Revision Effective Date: 01/01/2008
CODING GUIDELINES:
Added E1035.

06/01/2007 - In accordance with Section 911 of the Medicare Modernization Act of 2003, Virginia and West Virginia were transitioned from DME PSC TriCenturion (77011) to DME PSC TrustSolutions (77012).

Revision Effective Date: 01/01/2007
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Moved bundling table to Coding Guidelines Section.
CODING GUIDELINES:
Included heavy duty and bariatric lifts in the existing lift codes. Added definition for E0625.

03/01/2006 - In accordance with Section 911 of the Medicare Modernization Act of 2003, this article was transitioned to DME PSC TriCenturion (77011) from DMERC Tricenturion (77011).

Revision Effective Date: 01/01/2005
LMRP converted to LCD and Policy Article
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
E0639, E0640 added

 

Related Documents 

 

LCD(s)
L5064 - Patient Lifts