Therapeutic chairs are specialized seating systems that are adapted to accommodate persons with a physical handicaps. Therapeutic chairs may be necessary to allow persons with disabilities to perform transfers or other essential daily activities, or to facilitate their optimal positioning.

Scope of Policy

This Clinical Policy Bulletin addresses therapeutic chairs.

Medical Necessity

Aetna considers the following specialized therapeutic chairs, seats, and benches medically necessary DME by Aetna's traditional plans according to the selection criteria set forth below:

Specialized Therapeutic Chairs

Total hip chairs and other raised therapeutic chairs:

Total hip chairs and other therapeutic chairs with elevated seats enable members to sit without having to lower their body to the normal level of a regular chair. Aetna traditional plans consider these chairs as DME for members with any of the following conditions:

Aetna HMO plans follow Medicare rules regarding total hip chairs or other raised therapeutic chairs. Medicare considers total hip chairs or other raised therapeutic chairs non-covered personal convenience items.

Auto tilt chairs:

Auto tilt chairs, which can tilt forward, can be useful for members who have difficulty getting in and out of chairs. Aetna's traditional plans consider auto tilt chairs as DME for members with impaired ability to raise or lower self due to physical handicap, disease, or injury. Desk tilt chairs, which tilt backwards (not forwards), are considered non-covered personal convenience items.

Aetna HMO plans follow Medicare rules regarding auto-tilt chairs; Medicare considers auto tilt chairs non-covered personal convenience items.

Posture support chairs:

Aetna's traditional plans consider posture support chairs as DME when they are needed to provide support for physically handicapped persons with impaired head and trunk control due to weakness or spasticity.

Aetna's HMO plans follow Medicare rules for posture support chairs; Medicare considers posture support chairs non-covered personal convenience items.

Transfer benches:

Aetna's non-HMO plans consider transfer benches as DME where a physical handicap, disease, or injury inhibits the member's ability to raise or lower himself or herself.

Aetna HMO plans follow Medicare rules regarding transfer benches; Medicare considers transfer benches non-covered personal convenience items.

Specialized Therapeutic Chairs Used Primarily for Children

Corner chairs:

Corner chairs are used primarily for children who, because of a handicap, need postural support while sitting on the floor. Aetna traditional plans consider corner chairs as DME when needed to provide support for physically handicapped children.

Aetna's HMO plans follow Medicare rules regarding chairs; Medicare considers corner chairs non-covered personal convenience items.

Feeder seats:

Feeder seats are soft foam seats with positioning straps that are used for feeding, resting, and other situations. They are portable, and can be placed directly on the floor, in an adult's lap, or into a stroller. Aetna's traditional plans consider feeder seats as DME for children, who, because of postural instability or weakness, need a chair with shoulder harnesses and shoulder straps to maintain their position while seated.

Aetna's HMO plans follow Medicare rules regarding feeder seats; Medicare considers feeder seats non-covered personal convenience items.

Carrie seats:

Carrie seats are much like feeder seats, but have a rear strap, which allows them to be placed on a regular chair. They also come with a headrest and adjustable footrest. Aetna's traditional plans consider Carrie seats as DME for children, who, because of postural instability or weakness, need a chair with shoulder harnesses and shoulder straps to maintain their position while seated.

Aetna's HMO plans follow Medicare rules; Medicare considers Carrie seats non-covered personal convenience items.

Floor sitters:

Floor sitters include a feeder seat (see above) and floor sitter wedge to hold the feeder seat upright. Aetna's traditional plans consider floor sitters as DME for children, who, because of postural instability or weakness, need a chair with shoulder harnesses and shoulder straps to maintain their position while seated on the floor.

Aetna's HMO plans follow Medicare rules regarding floor sitters; Medicare considers floor sitters non-covered personal convenience items.

Versa form chair:

The Versa form chair is a customizable, semi-permanent positioning support that is molded to the shape of the body. Density and firmness are controlled by applying vacuum to the chair. Aetna's traditional plans consider Versa form chairs as DME for children with postural instability who, because of a physical deformity, need a chair with postural support that conforms to the shape of their body.

Aetna's HMO plans follow Medicare rules for Versa form chairs; Medicare considers Versa form chairs non-covered personal convenience items.

Adjustable high chairs:

Seats with adjustable depth, back, and footrest (e.g., Kaye Kinder chairs, Trip Trap chairs) may be useful for handicapped children with postural weakness or instability to provide stability and support, maintain body alignment, decrease the likelihood of postural deformities, and enhance hand use functions. Chairs with adjustable back, depth, and footrest can function as a high chair for children with disabilities. Children can be properly seated in thigh depth, back height, and foot support. Aetna's traditional plans consider adjustable high chairs as DME for children who, because of a physical handicap, deformity, or weakness, are unable to use a standard high chair and need an adjustable high chair.

Aetna's HMO plans follow Medicare rules for adjustable high chairs; Medicare considers these adjustable high chairs non-covered personal convenience items.

Plan Limitations and Exclusions

Aetna HMO plans (HMO, QPOS, Health Network Only, Health Network Option, and Medicare Advantage) do

cover the specialized therapeutic chairs, seats, and benches listed above regardless of whether or not the HMO member has a durable medical equipment (DME) benefit. Aetna's HMO plans follow Medicare's coverage rules for these kinds of DME and Medicare does not cover these chairs as they are considered personal convenience items.

Aetna traditional plans (indemnity, PPO, and Managed Choice POS) consider specialized therapeutic chairs, seats, and benches medically necessary DME to enable the member to perform essential activities of daily living related to the member's health and hygiene, within or outside the home, with minimal or no assistance from others.

Aetna does

cover chairs, seats, and benches that are not mainly used to perform these essential daily activities, and/or which are normally of use to persons who do not have a disease or injury because they do not meet Aetna's contractual definition of covered DME.

Please check benefit plan descriptions for details.

* Note: The following are examples of chairs that are not covered DME because they are not mainly used in the treatment of disease or injury, are not primarily medical in nature, and/or are normally of use to persons who do not have a disease or injury: