Medicare Coverage Guidelines for Seatlifts

A seat lift mechanism is covered if all of the following criteria are met:
1) The patient must have severe arthritis of the hip or knee or have a severe neuromuscular disease.
2) The seat lift mechanism must be a part of the physicians' course of treatment and be prescribed to effect improvement, or arrest or retard deterioration in the patient's condition.
3) The patient must be completely incapable of standing up from a regular armchair or any chair in their home. (The fact that a patient has difficulty or is even incapable of getting up from a chair, particularly a low chair, is not sufficient justification for a seat lift mechanism. Almost all patients who are capable of ambulating can get out of an ordinary chair if the seat height is appropriate and the chair has arms.)
4) Once standing, the patient must have the ability to ambulate. Coverage of seat lift mechanisms is limited to those types which operate smoothly, can be controlled by the patient and effectively assist a patient in standing up and sitting down without other assistance. Excluded from coverage is the type of lift which operates by spring release mechanism with a sudden catapult-like motion and jolts the patient from a seated to a standing position.
Coverage is limited to the seat lift mechanism, even if it is incorporated into a chair. Payment for a seat lift mechanism incorporated into a chair is based on the allowance for the least costly alternative.
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. The physician's recorded must document that all appropriate therapeutic modalities(e.g., medication, physical therapy) have been tried and failed to enable the patient to transfer from a chair to a standing position.

Excerpt from the Region B DMERC Supplier Manual - Revision40-June 2004