Documentation needs Seat Lift Mechanism (ACA, Face to Face visit is required)

The following qualification criteria need to be documented in the patients’ medical record notes to qualify for the prescribed equipment. Note: Face to face and justification notes are valid for six months.

All of the following need to be sufficiently documented to support the need for the prescribed equipment.

Note: The physician ordering the seat lift mechanism must be the treating physician or a consulting physician for the disease or condition resulting in the need for a seat lift. 

  • Explain the patient’s severe arthritis of the hip or knee, or severe neuromuscular disease.
  • Explain the seat lift mechanism is part of the physician’s course of treatment, and how it is prescribed to effect improvement, or arrest or retard deterioration in the patient’s condition.

Note: The physician’s record must document that all appropriate therapeutic modalities (e.g., medication, physical therapy) have been tried and failed to enable the beneficiary to transfer from a chair to a standing position.

  • Explain the patient’s complete incapability of standing up from a regular armchair in their home.

Note: The fact that a beneficiary has difficulty or even incapable of getting up form a chair, particularly a low chair, is not sufficient justification for a seat lift mechanism. Almost all beneficiaries who are capable of ambulating can get out of an ordinary chair if the seat height is appropriate and the chair has arms.

  • Explain the patient’s ability to ambulate once standing.

Diagnosis: See LCD (Local coverage determination) at CGSMedicare.com for any additional qualifying information questions, diagnosis codes and descriptions

Medicare approved detailed equipment descriptions for seat lift mechanism

Seat lift Mechanism incorporated lift chair, (HCPC-E0627)

Patient notes/justification – Must be documented using your normal dictation process. Letter of medical necessity, notes wrote on letterhead or prescriptions are not valid.

Prescription/order requirements– Must contain Patient’s name, date of the order and Start date, detailed equipment description (See above), Physician’s NPI (national provider number), signature of the ordering physician and a signature date.

10/17