HIGHMARK COMMERCIAL MEDICAL POLICY - PENNSYLVANIA

 
 

Medical Policy:
E-8-016
Topic:
Patient Lifts
Section:
Durable Medical Equipment
Effective Date:
September 18, 2017
Issued Date:
January 28, 2019
Last Revision Date:
January 2019
Annual Review:
January 2019
 
 

Patient lifts are devices (hydraulic, mechanical, electric) that are designed to provide a means of transferring a person safely from one area to another and back when the individual is unable to assist with the transfer.

Policy Position

Patient lifts are covered when the individual's condition is such that periodic movement is necessary to effect improvement or to arrest/retard deterioration in his condition. 

Patient lifts may be considered medically necessary DME:

  • If one of the following conditions is met; and
  • If transfer between bed and a chair, wheelchair, or commode requires the assistance of more than 1 person and, without the use of a lift; the member would be bed-confined.

Medically necessary conditions:

  • Advanced degenerative muscular diseases such as: muscular dystrophy
  • Bilateral amputee
  • Coma
  • Contractures (rigidity)
  • Degenerative joint disease
  • Fracture pelvis or spine
  • Hip spica or body cast
  • Paralysis (hemiplegia, paraplegia, quadriplegia, hemiparesis)
  • Rheumatoid arthritis
  • Severe congestive heart failure
  • Severe neurological disorders such as: multiple sclerosis, amyotrophic lateral sclerosis, syringomyelia, spinal cord tumors, advanced cerebellar degeneration
  • Stroke (CVA or cerebral vascular accident)

When the individual's condition is other than one listed above, the claim should be referred for medical review to determine medical necessity for the lift.

Requests not meeting the above criteria should be denied as non-covered. 

NOTE: Total payments for a rental item may not exceed its allowable purchase price, except for those items identified as life sustaining DME.

 

E0621

E0630

E0635

E0639

 

 

 

 

 

 

 

 

 

 




The following types of patient lifts are not covered because they do not meet the definition of covered durable medical equipment (DME) or because they are considered home modifications: 

  • Patient lifts used primarily to move a patient in or out of the bathtub; and
  • Auto lifts ( used to lift a wheelchair into a car, truck or van); and
  • Wheelchair lifts or ramps (e.g., Wheel-O-Vator lift)(provides access to stairways or car trunks); and
  • Ceiling lifts (patient lifts mounted on tracks that are attached to the ceiling); and
  • Platform lifts, stair lifts, and stairway elevators.

E0625

E0640

E1399

 

 

 

 




Related Policies

Refer to medical policy E-38 Continuous Rental of Life Sustaining Durable Medical Equipment (DME) for additional information.


Place of Service: Outpatient

The use of Patient Lifts 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.


The policy position applies to all commercial lines of business



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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 or other circumstances may warrant individual consideration, based on review of applicable medical records, as well as other regulatory, contractual and/or legal requirements.

Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.

Highmark retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.

Discrimination is Against the Law
The Claims Administrator/Insurer complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The Claims Administrator/Insurer does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. The Claims Administrator/ Insurer:

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)

  • Provides free language services to people whose primary language is not English, such as:
  • Qualified interpreters
  • Information written in other languages
  • If you need these services, contact the Civil Rights Coordinator.

    If you believe that the Claims Administrator/Insurer has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, P.O. Box 22492, Pittsburgh, PA 15222, Phone: 1-866-286-8295, TTY: 711, Fax: 412-544-2475, email: CivilRightsCoordinator@highmarkhealth.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you.

    You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

    U.S. Department of Health and Human Services
    200 Independence Avenue, SW
    Room 509F, HHH Building
    Washington, D.C. 20201
    1-800-368-1019, 800-537-7697 (TDD)

    Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

    Insurance or benefit/claims administration may be provided by Highmark, Highmark Choice Company, Highmark Coverage Advantage, Highmark Health Insurance Company, First Priority Life Insurance Company, First Priority Health, Highmark Benefits Group, Highmark Select Resources, Highmark Senior Solutions Company or Highmark Senior Health Company, all of which are independent licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.