This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Seat lift mechanisms may be considered medically necessary when ALL of the following are met:

• Ordered by the treating physician; and
• Prescribed to effect improvement or to attest or retard deterioration in the patient’s condition; and
• Patient has severe arthritis of the hip or knee or has a severe neuromuscular disease; and
• Patient completely incapable of standing up from a regular armchair or any chair in their home; and
• Once standing, the patient must have the ability to ambulate.

Coverage of seat lift mechanisms is limited to those types that meet ALL of the following:

• Operates smoothly; and
• Can be controlled by the patient; and
• Effectively assist a patient in standing up and sitting down without other assistance.

Seat lifts that operate by spring release mechanism with a sudden, catapult-like motion and jolt the patient from a seated to a standing position are not medically necessary.

The medical necessity for the seat lift mechanism must be documented in the patient’s medical record and must be available upon request.

In addition, 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. In order for payment to be made, this order must be received by the supplier prior to delivery of the item.

Seat lift mechanisms that do not meet the criteria of this policy will not be considered medically necessary.

The use of Seat Lift Mechanisms is typically an outpatient procedure which is only eligible for coverage as an inpatient procedure in special circumstances, including, but not limited to, the presence of a co-morbid condition that would require monitoring in a more controlled environment such as the inpatient setting.

Services that do not meet the criteria of this policy will not be considered medically necessary. A network provider cannot bill the member for the denied service unless: (a) the provider has given advance written notice, informing the member that the service may be deemed not medically necessary; (b) the member is provided with an estimate of the cost; and (c) the member agrees in writing to assume financial responsibility in advance of receiving the service. The signed agreement must be maintained in the provider’s records.

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