01-157 Patient Lifts Notification of Medical Review
Noridian Healthcare Solutions, LLC (Noridian), as the Supplemental Medical Review Contractor (SMRC) for the Centers of Medicare and Medicaid Services (CMS), is conducting post-payment review of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) patient lifts billed with dates of service January 1, 2023, through November 30, 2025. This notification includes the reasons for the review, documentation that will be requested in the Additional Documentation Request (ADR) letter, and resources providers/suppliers may wish to consult when submitting claims.
Background
Patient lifts are medical equipment used by caregivers and beneficiaries to transfer the beneficiary from one location to another, which may include but not limited to: bed, chair, tub, or commode. The use of a patient lift is necessary to prevent the beneficiary from being confined to one location. While patient lifts are used in nursing facilities and hospitals, they are also covered within the beneficiary’s home when determined to be reasonable and necessary. Patient lifts can be operated manually, electrically powered, or with hydraulics. Transferring a beneficiary with a patient lift provides both the beneficiary and the caregiver a safer and more efficient process.
Patient lifts are covered under the DMEPOS benefit. To be eligible for reimbursement, a beneficiary must meet the reasonable and necessary criteria outlined within the Local Coverage Determination (LCD) L33799, Patient Lifts.
The 2024 Comprehensive Error Rate Testing (CERT) report identified a projected improper payment rate of 25.4% for patient lifts. In January 2025, Noridian completed research and data analysis on patient lifts and identified a spike in billing in recent years.
Reason for Review
The SMRC is tasked to perform data analysis and conduct medical record reviews on patient lift Healthcare Common Procedure Coding System (HCPCS) codes E0630, E0635, E0636, E1035, or E1036 billed with dates of service January 1, 2023, through November 30, 2025.
The SMRC will conduct medical record reviews in accordance with applicable waivers/flexibilities/statutory, regulatory, and sub-regulatory guidance.
Claim Sample Detail
| HCPCS | Description |
|---|---|
| E0630 | Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
| E0635 | Patient lift, electric with seat or sling |
| E0636 | Multi-positional patient support system, with integrated lift, patient accessible controls |
| E1035 | Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs |
| E1036 | Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs |
Access related project details below.
Documentation Requirements
Below is a list of specific documentation requirements that will be included in each ADR to obtain the necessary documentation to perform the review.
Providers/suppliers are requested to submit each of the documentation requirements outlined below, if and as applicable to the claim on review.
- Standard Written Order (SWO)
- Documentation to support the code(s) and modifier(s) billed
- Medical record documentation to support national and local requirements
- Medical record documentation to support the patient lift provided is reasonable and necessary
- Medical record documentation to support the beneficiary would be bed confined without the use of the lift
- Medical record documentation to support the beneficiary requires supine positioning for transfers, if applicable
- Proof of Delivery
- Any other supporting/pertinent documentation
- Advance Beneficiary Notice of Non-Coverage (ABN)/Notice of Medicare Non-Coverage (NOMNC)
- If an electronic health record is utilized, include your facility’s process of how the electronic signature is created. Include an example of how the electronic signature displays once signed by the physician
- Providers/suppliers are encouraged to review the documentation prior to submission, to ensure that signature information is available when authenticity is not conclusively documented. Please include a signature log or signature attestation for any missing or illegible signature within the medical record
- If medical record documentation is submitted via esMD: Beneficiary identification, date of service, and provider of the service should be clearly identified on each page of the submitted documentation
- Please Note: The supplier or provider is responsible for obtaining all documentation from the ordering/referring provider to ensure medical necessity criteria have been met.
References
Social Security Act (SSA) Title XI
- Section (§)1135 Authority to Waive Requirements During National Emergencies
SSA Title XVIII
- §1815(a) Payment to Providers of Services
- §1833(e) Payment of Benefits
- §1834(a) Payment for Durable Medical Equipment
- §1842(p)(4) Provisions Relating to the Administration of Part B
- §1861(n) Durable Medical Equipment
- §1862(a)(1)(A) Exclusions from Coverage and Medicare as Secondary Payer
- §1877(g) Sanctions
- §1879(a) Limitation on Liability of Beneficiary Where Medicare Claims are Disallowed
- §1893(a)(b) Medicare Integrity Program
Code of Federal Regulations (CFR) Title 42
- §410.38 Durable Medical Equipment: Scope and Conditions
- §411.15(k)(1) Particular Services Excluded from Coverage
- §414.200 Purpose
- §414.229 Other Durable Medical Equipment – Capped Rental Items
- §424.5(a)(6) Basic Conditions
Federal Register
- Interim Final Rule with Comments Volume 85, No. 66, Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID–19 Public Health Emergency. Effective March 1, 2020. Retrieved from 2020-06990.pdf (govinfo.gov)
- IFC 85 FR 19230. Revisions in Response to the COVID-19 Public Health Emergency. CMS-1744-IFC. Effective March 1, 2020. Retrieved from CMS-1744-IFC
Internet-Only Manual (IOM), Publication (Pub.) 100-03, Medicare National Coverage Determinations Manual (MNCDM)
- Chapter (Ch.) 1, Part 4, § 280.1 Durable Medical Equipment Reference List
IOM, Pub. 100-02, Medicare Benefit Policy Manual (MBPM)
- Ch. 15, §110 Durable Medical Equipment – General
- Ch. 16 General Exclusion from Coverage
IOM, Pub. 100-04, Medicare Claims Processing Manual (MCPM)
- Ch. 1 General Billing Requirements
- Ch. 20 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
- Ch. 20, §30.5 Capped Rental Items
- Ch. 23, §20.9 National Correct Coding Initiative (NCCI)
- Ch. 30, §50 Advance Beneficiary Notice of Non-coverage (ABN)
IOM, Pub. 100-08, Medicare Program Integrity Manual (MPIM)
- Ch. 3 Verifying Potential Errors and Taking Corrective Actions
- Ch. 4, §4.7.3.1 Supplier Proof of Delivery Documentation Requirements
- Ch. 5 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items and Services Having Special DME Review Considerations
- Ch. 13, §13.5.4 Reasonable and Necessary Provisions in LCDs
CMS Coding Policies
- National Correct Coding Initiative Edits (NCCI). NCCI Policy Manual for Medicare Services. Effective January 1, 2023
Local Coverage Determination (LCDs)
- L33799 Patient Lifts. Effective October 1, 2015
Local Coverage Articles (LCAs)
- A52516 Patient Lifts-Policy Article. Effective October 1, 2015
- A55426 Standard Documentation Requirements for All Claims Submitted to DME MACs, Effective January 1, 2017
Other
- American Medical Association (AMA), Current Procedural Terminology (CPT). 2023, 2024, 2025. CPT® (Current Procedural Terminology) | AMA
- American Academy of Professional Coders (AAPC). Medical Coding – Medical Billing – Medical Auditing – AAPC
- Centers for Medicare and Medicaid Services (CMS). Durable Medical Equipment, Prosthetics, Orthotics and Supplies: CMS Flexibilities to Fight COVID-19. May 10, 2023. Retrieved from Durable Medical Equipment, Prosthetics, Orthotics and Supplies: CMS Flexibilities to Fight COVID-19
- CMS. 0020 Patient Lifts: Medical Necessity and Documentation Requirements. May 9, 2017. Retrieved from 0020 – Patient Lifts: Medical Necessity and Documentation Requirements | CMS
- CMS. 2024 Medicare Fee-for-Service Supplemental Improper Payment Data. Retrieved from 2024 Medicare Fee-for-Service Supplemental Improper Payment Data
- CERT. 2023 Medicare Fee-for-Service Supplemental Improper Payment Data. December 7, 2023. Retrieved from Medicare Fee-for-Service 2023 Improper Payments Report
- Pricing, Data Analysis and Coding (PDAC). Durable Medical Equipment Coding System (DMECS). 2024. Retrieved from Palmetto GBA – DMECS
- Provider Compliance Tips for Patient Lifts. Retrieved from Patient Lifts
Last Updated Feb 12, 2026