For E1035/E1036 (Barton Transfer Chairs)
Basic Coverage Criteria
ALL of the following must be met:
- 1. Transfer between bed and chair/wheelchair/commode is required
- 2. Without transfer system, beneficiary would be bed confined
- 3. Beneficiary requires supine positioning for transfers
- 4. E1036 (Extra-wide) is covered when patient weight exceeds 300 lbs
Documenting Medical Necessity
1. Required Elements
- Need for bed to chair/commode transfers
- Inability to transfer without supine positioning
- Risk of bed confinement without device
- Weight (if ordering E1036)
- Why other transfer methods are insufficient
- Caregiver ability to operate device
2. Sample Documentation Language
Initial Assessment Example: “Patient requires transfers between bed and [chair/wheelchair/commode] [X] times daily. Supine positioning during transfers required due to [specific condition/complications]. Unable to maintain seated position during transfers due to [specific medical reason]. Patient weight [X] lbs. Without multi-positional transfer system, patient would be bed-confined due to inability to safely transfer. Standard lift insufficient due to need for full supine support during positioning changes.”
Clinical Findings Example: “Patient demonstrates:
- Inability to maintain seated position due to [specific condition]
- Requirements for full-body support during transfers due to [specific reason]
- Risk of [specific complications] without supine positioning
- Failed attempts at other transfer methods including [list methods] due to [specific reasons]"
Plan Example: “Multi-positional transfer system (E1035/E1036) prescribed to:
- Enable safe supine transfers while maintaining proper body alignment
- Prevent bed confinement
- Allow essential transfers for toileting and positioning
- Accommodate patient's size and medical conditions
- Reduce risk of injury to both patient and caregiver"
- Enable safe supine transfers while maintaining proper body alignment
- Prevent bed confinement
- Allow essential transfers for toileting and positioning
- Accommodate patient's size and medical conditions
- Reduce risk of injury to both patient and caregiver"
Required Documentation Components
1. Initial Coverage Documentation:
- Face-to-face encounter notes
- Physical assessment details
- Functional limitation description
- Transfer requirement specifics
- Failed alternative methods
- Weight documentation (for E1036)
- Caregiver assessment
- Home environment evaluation
2. Standard Written Order (SWO) Requirements:
- Beneficiary name
- Detailed equipment description (E1035 or E1036)
- Any required accessories
- Order date
- Prescriber's signature
- Prescriber's NPI
Common Documentation Pitfalls to Avoid
❌ Not documenting why supine positioning is required
❌ Missing documentation of failed alternative methods
❌ Incomplete weight documentation for E1036
❌ No documentation of caregiver training/capability
❌ Failing to address discontinuation of other mobility devices
❌ Insufficient justification for medical necessity
Practical Documentation Tips
1. Medical Necessity Example: “Patient requires supine transfers due to:
- Severe positional hypotension with syncope in seated position
- Multiple contracted joint deformities preventing seated transfers
- High risk of skin breakdown with traditional lift slings
- History of traumatic injury during previous seated transfer attempts"
2. Failed Alternatives Example: “Previous transfer methods attempted and failed:
- Standard Hoyer lift: Caused severe pain and skin shearing
- Seated transfer board: Unable to maintain position due to tone
- Manual transfers: Resulted in caregiver injury on [date]
- Gait belt: Unable to support patient's weight safely"
3. Caregiver Competency Example: “Primary caregiver (spouse) demonstrates:
- Understanding of all system components and functions
- Ability to safely operate transfer mechanisms
- Competency with positioning adjustments
- Knowledge of emergency protocols
- Physical capability to manage system
Medicare Documentation Checklist
Initial Coverage: ✓ Face-to-face encounter documentation ✓ Medical necessity for supine positioning ✓ Failed alternative transfer methods ✓ Patient weight (for E1036) ✓ Caregiver training completion ✓ Home environment assessment ✓ Standard Written Order ✓ Documentation of other mobility equipment to be discontinued
Special Considerations
1. Required PDAC Verification:
- Device must be listed on PDAC Product Classification List
- Claim will deny if product not verified for specific code
2. Modifiers:
- KX: Use when all coverage criteria met
- GA: Use with ABN when denial expected
- GZ: Use when criteria not met, no ABN
3. Other Considerations:
- Must document acknowledgment of discontinuing other mobility devices
- Regular follow-up needed to ensure continued safe use
- Changes in patient status must be documented
Remember: All documentation must be completed BEFORE submitting the order and must be maintained in the patient’s medical record. The documentation must clearly establish why supine positioning is required and why other transfer methods are insufficient.
Follow-up Documentation
Every visit should document:
- Continued medical necessity
- Safe and effective use
- Any complications or issues
- Changes in patient status
- Caregiver competency maintenance
- Equipment condition and function
Important Coverage Note
When E1035 or E1036 is covered, Medicare will DISCONTINUE payment for:
- Canes
- Crutches
- Walkers
- Rollabout chairs
- Transfer chairs
- Manual wheelchairs
- Power-operated vehicles
- Power wheelchairs
