Patient Lifts

Affected Providers

Treating practitioners and DME suppliers who bill for patient lifts.

HCPCS & CPT Codes

Local Coverage Determination (LCD): Patient Lifts (L33799) has the current HCPCS and CPT codes. 

Background

According to the 2024 Medicare Fee-for-Service Supplemental Improper Payment Data, the improper payment rate for patient lifts is 25.4%, with a projected improper payment amount of $3 million.

We cover patient lifts under the DME benefit. You must meet the provisions in National Coverage Determination (NCD): Durable Medical Equipment Reference List (280.1). We outline other policy requirements in LCD L33799.

Denial Reasons

Insufficient documentation accounted for 91.8% of improper payments for patient lifts during the 2024 reporting period, while no documentation (8.2%) also caused improper payments.

Preventing Denials

We cover:

• A patient lift (HCPCS codes E0630, E0635, E0639, and E0640) for transfers between a bed and a chair, wheelchair, or commode if the patient would be confined to a bed without it
• A multi-positional patient transfer system (HCPCS codes E0636, E1035, and E1036) if the patient meets these criteria:
  • Basic coverage criteria for a lift

  • Requires supine positioning for transfers

    Note: If we cover E1035 or E1036, we deny payment for any other mobility assistive equipment, including, but not limited to, canes, crutches, walkers, rollabout chairs, transfer chairs, manual wheelchairs, power-operated vehicles, or power wheelchairs.

• HCPCS code E0621 as an accessory when ordered as a replacement for a covered patient lift

Documentation Requirements

To justify payment, you must meet specific requirements when ordering DMEPOS.

Example of Improper Payments Due to Insufficient Documentation for Patient Lifts

A supplier bills the claim for E0636 (Multi-positional patient support system, with integrated lift, patient accessible controls) and submits the following documentation per the review contractor’s request:

• Standard written order with correct HCPCS coding
• Treating practitioner’s medical record that doesn’t meet criteria for reasonable and necessary
• Proof of delivery

What Documentation Was Missing?

Although the patient’s medical record provided documentation that met the basic coverage criteria for a lift, it didn’t have a complete description stating the patient requires supine positioning for transfers.

What Happens Next?

The review contractor completes the claim as an insufficient documentation error, and the Medicare Administrative Contractor recoups payment.

Recommendation

To justify payment, the certifying physician must document in the patient’s medical record that the patient meets coverage criteria for a lift and that they require supine positioning for transfers.