Patient Lifts (e.g., Hoyer, Saralift, Seat Lift, Chair Mechanisms, and Ceiling Lifts) 1.01.08

Immediately upon notice: (1) Billing team must update billing system to deny claims for HCPCS codes E0625 (bathroom/toilet lifts), and flag for manual review any claims for ceiling lifts, platform lifts, stair lifts, stairway chairs, powered wheelchair lifts, and van lifts—these are NOT covered under this policy. (2) Update claim submission protocols to require physician documentation for ALL approved lift claims (E0621, E0627, E0629, E0630, E0635, E0637) including: date of DME initiation, warranty information, patient compliance attestation, and confirmation that transfer requires 2+ persons OR patient would be confined to bed without the lift. (3) For seat lift mechanisms (E0627, E0629, E0637), implement requirement that providers document EITHER severe hip/knee arthritis OR all four criteria for neuromuscular disease (failed conservative treatment, inability to stand from chair, ability to ambulate once standing). (4) Create prior authorization workflow requiring these elements before claim submission to prevent denials. (5) For repair/replacement claims, require physician attestation that equipment is no longer functioning adequately and repair cost does not exceed replacement cost. Failure to obtain required documentation will result in claim denials. This policy supersedes any prior guidance on patient lifts for Excellus members.