Appeal type: Medical necessity
Decision: Upheld

Diagnosis: Neck pain; back pain
Treatment: Ergonomic Computer Chair (code: E1399)
The insurer denied: Ergonomic Computer Chair (code: E1399)
The denial is upheld.

The patient is an adult male who started visiting a chiropractic practice some months ago. A letter from the chiropractor noted that the chiropractor believed that the patient's chronic mid and upper back pains were directly related to his computer set up and his current chair. It was recommended that he use a "proper ergonomic chair." It was opined by the chiropractor that a 
proper ergonomic chair is "medically necessary and appropriate."
A letter by a nurse practitioner for a family medicine practice noted that the nurse practitioner supported the recommendation made by the chiropractor to minimize pain and other symptoms. No detailed clinical data, including physical examination findings, work up (if any), or history of other treatments (if any) for the patient's symptoms was included in the material available for review. The health plan denied coverage of the chair under review, indicating that the chair is non-medical in nature and used primarily and customarily for a non-medical purpose, even though the item may have some remotely medically related use. The patient is appealing the denial of the claim for the Herman Miller "Embody Gaming Chair"."

The requested Ergonomic Computer Chair is not medically necessary.

Neck and back discomfort/pain, as well as other musculoskeletal complaints, are highly prevalent among sedentary workers, including office workers and persons teleworking from home. Factors that may be associated with these complaints can include a suboptimal ergonomic set up, including improperly placed computer work screens/keyboards, lack of foot contact with the ground (or footrests), and insufficient back rest supports on chairs, as well as office furniture that may simply be uncomfortable or poorly designed. Workers often self-manage their symptoms, to variable effect, using strategies such as taking more breaks to get up and move around, using seat cushions, using different types of chairs, and using sit-stand height-adjustable tables. The evidence related to formal interventions to prevent and/or to address the symptomatology associated with sedentary/office work, unfortunately, is very low quality. The available evidence suggests that interventions including exercises for strengthening, and ergonomics adjustments might be effective in preventing and/or improving some symptoms associated with sedentary/office work (such as eye strain, neck pains, finger pains, shoulder pains, and back pains), but there is no clear consensus on best practices, and ultimately each case needs to be assessed individually. In the present case, the patient reports that he has had neck, shoulder, and back pain that started at some unclear time point related to the start of work. Clinically relevant details about symptom 
chronicity, symptom characteristics, examination findings, and work up (if any) are not provided in the available documentation. It is also not evident what treatment or management was pursued related to his complaints, prior to the recommendation for the chair in question, outside of a suggestion that he may have received a short period of chiropractic manipulation. It is unclear what specific ergonomic evaluations were completed, if any, related to the patient's workplace, including any evaluation of the patient's prior chair. Overall, while it is reasonable for a person to desire a more comfortable and more supportive chair for vocational or non-vocational purposes, this is largely a subjective issue and ultimately a comfort/convenience item and not a medical need. There is no compelling evidence that the patient in this case required the Herman Miller "Embody Gaming Chair" in question for a medical purpose. This chair is furniture that has no proven health or functional benefit over other chairs that aim to provide comfort and support for any persons who might elect to sit in them.