Does E0629 require prior authorization?

Yes, E0629 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

`E0629`, Seat lift mechanism, non-electric, any type

HCPCS/CPT

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted.
For DMEPOS base items that require a Written Order Prior to Delivery (WOPD), the supplier must have received a signed SWO/WOPD prior to delivery of the item.
WOPD for base items requiring it must list the base item and may list separately billed associated options, accessories, and supplies prior to delivery.
Practitioner's medical record must document that appropriate therapeutic modalities (e.g., medication, physical therapy) were tried and failed to enable transfer from a chair to standing.

Beneficiary has severe arthritis of the hip or knee, or has a severe neuromuscular disease.
Seat lift mechanism is part of the treating practitioner's course of treatment and is prescribed to effect improvement or to arrest/retard deterioration.
Beneficiary is completely incapable of standing up from a regular armchair or any chair in their home (simple difficulty or inability with low chairs alone is insufficient).
Once standing, the beneficiary must have the ability to ambulate.
Covered seat lift mechanisms must operate smoothly, be controllable by the beneficiary, and effectively assist standing up and sitting down without other assistance.
Practitioner ordering the seat lift must be the treating or consulting practitioner for the disease/condition that necessitates the device.

ANTHEM-CG-DME-25, Seat Lift Mechanisms

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

L33801, Seat Lift Mechanisms

AETNA-CPB-0429, Bathroom and Toilet Equipment and Supplies

REGENCE-DME23, Patient Lifts and Seat Lifts

Ask Backwork about documentation requirements, denial risks, or coverage in your state.