Detailed Explanation of Hoyer Lift Medicare Requirements: The Latest Reimbursement Guide for 2025–2026

For elderly individuals or people with disabilities in need of long-term care, Hoyer Lifts are critical equipment for ensuring safe transfers, preventing falls, and reducing caregiving burdens. However, their high cost (typically between $1,500 and $3,500) deters many families. Fortunately, the U.S. federal Medicare program covers Hoyer Lifts—but only if a series of strict medical necessity, documentation, and procedural requirements are met.

This article provides a comprehensive breakdown of Medicare’s latest coverage policies for Hoyer Lifts in 2025–2026, including eligibility criteria, required documents, application processes, common reasons for claim denials, and practical advice. It aims to help patients and their families successfully obtain reimbursement support.

I. Does Medicare Cover Hoyer Lifts?

Yes, but coverage is limited to Medicare Part B (Medical Insurance) and only applies to Durable Medical Equipment (DME). Specifically:

Electric Hoyer Lifts (HCPCS code E0635): Covered for eligible beneficiaries.

Manual Hoyer Lifts (e.g., hydraulic pump models): Generally not covered, as Medicare deems their "non-electric" design failing to meet the "reasonable and necessary" standard (approval may be granted in extremely special cases following an appeal).

Slings (code E0639): Starting in 2026, slings can be reimbursed independently (up to 2 slings per year).

⚠️ Note: Medicare does not cover the full cost of purchase. Instead, it pays 80% of the approved amount, with the remaining 20% covered by the beneficiary (unless supplemented by Medigap insurance).

II. Core Eligibility Criteria: What Constitutes "Medical Necessity"?

Medicare requires Hoyer Lifts to meet all the following conditions to be considered "Reasonable and Necessary":

1. The patient cannot independently transfer between bed and chair

Must be assessed as "Total Dependence" or "Maximal Assist" for transfers.

Patients requiring only "Supervision" or "Minimal Assist" do not qualify.

2. Clear medical diagnosis support is required

Commonly accepted ICD-10 diagnoses include:

G20: Parkinson’s disease

I69.351: Hemiplegia of right side following cerebral infarction

M80.08XA: Age-related osteoporosis with current pathological fracture

Z74.01: Bedridden state

S72.001A: Fracture of neck of femur, initial encounter

❌ Vague descriptions such as "limited mobility," "weakness," or "old age" alone will result in claim denial.

3. The patient has the cognitive and physical capacity to use the equipment

Able to follow instructions (e.g., "Please lift your hand").

No severe restlessness or aggressive behavior (additional safety assessment is required if present).

Weight falls within the equipment’s weight capacity (≤ 350 lbs for standard models).

III. Required Document Checklist (None Can Be Omitted)

To successfully apply for Medicare reimbursement, the following complete document package must be submitted:

Document Requirements & Explanations

1. Written Order (Physician’s Prescription) Must be signed by an MD, DO, or NP, and include:

- Patient’s full name

- Specific equipment description (e.g., "Electric patient lift, E0635")

- Detailed functional justification (e.g., "Unable to stand from bed; requires two people for transfers")

- Supporting diagnosis (ICD-10 code)

2. Face-to-Face Encounter Record The physician must have conducted a face-to-face visit with the patient within 6 months before issuing the prescription, hoyer lift medicare requirements and document the transfer ability assessment in the medical record.

3. Functional Assessment Report (Highly Recommended) Issued by an Occupational Therapist (OT) or Physical Therapist (PT), describing:

- Transfer level (e.g., "Total Assist x2")

- Necessity of using a Hoyer Lift

- Recommended sling type

4. DME Supplier Information Must select a Medicare-certified DME supplier (searchable via Medicare.gov/supplier-directory).