Insurance does not reimburse for the chair. Insurance reimburses for the lifting mechanism under or incorporated in the chair. The patient/customer will have to pay out of pocket for the cost of the chair.
A seat lift mechanism is covered if all of the following criteria are met:
- The beneficiary must have severe arthritis of the hip or knee or have a severe neuromuscular disease.
- The seat lift mechanism must be a part of the treating practitioner’s course of treatment and be prescribed to effect improvement, or arrest or retard deterioration in the beneficiary's condition.
- The beneficiary must be completely incapable of standing up from a regular armchair or any chair in their home. (The fact that a beneficiary 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 beneficiaries who are capable of ambulating can get out of an ordinary chair if the seat height is appropriate and the chair has arms.)
- Once standing, the beneficiary must have the ability to ambulate.
The practitioner ordering the seat lift mechanism must be the treating practitioner or a consulting practitioner for the disease or condition resulting in the need for a seat lift. The practitioner's record must document that all appropriate therapeutic modalities (e.g., medication, physical therapy) have been tried and failed to enable the beneficiary to transfer from a chair to a standing position.