410-122-0365 Standing and Positioning Aids (1) Indications and limitations of coverage and medical appropriateness: Standing frame systems, prone standers, supine standers or boards, and accessories may be covered by the Division when conditions of coverage in OAR 410-122-0080 and the following criteria are met: (a) The client is unable to stand or ambulate independently due to conditions such as, but not limited to, neuromuscular or congenital disorders, including acquired skeletal abnormalities; (b) The client is at high risk for lower extremity contractures that cannot be appropriately managed by other treatment modalities (i.e., stretching, active therapy, home programs, etc) (c) The client has been sequentially evaluated by a physical or occupational therapist to make certain the client can tolerate a standing or upright position and obtain medical benefit; and, (d) The client is following a home therapy program for the stander established by a physical or occupational therapist; and (e) The home is able to accommodate the equipment; and (f) The weight of the client does not exceed manufacturer’s weight capacity; and (g) The client has demonstrated an ability to utilize the standing aid independently or with assistance from a caregiver; and (h) The client has demonstrated compliance with other programs; and (i) The client has demonstrated a successful clinical evaluation or trial period in a monitored setting; and (j) The client does not have access to equipment from another source. (2) Sidelyers and custom positioners shall meet the following criteria in addition to the criteria in Table 122-0365: (a) The client shall be sequentially evaluated by a physical or occupational therapist to make certain the client can tolerate and obtain medical benefit; and (b) The client shall be following a therapy program initially established by a physical or occupational therapist; and, (c) The home shall be able to accommodate the equipment; and (d) The caregiver or family are capable of using the equipment appropriately. (3) Criteria for Specific Accessories: (a) A back support may be covered when a client: (A) Needs balance, stability, or positioning assistance; or (B) Has extensor tone of the trunk muscles; or (C) Needs support while being raised or while completely standing; (b) A tall back may be covered when: (A) The client is over 5’11” tall; and (B) The client has no trunk control and needs additional support; or (C) The client has more involved need for assistance with balance, stability, or positioning; (c) Hip guides may be covered when a client: (A) Lacks motor control or strength to center hips; or (B) Has asymmetrical tone that causes hips to pull to one side; or (C) Has spasticity; or (D) Has low tone or high tone; or (E) Needs balance, stability, or positioning assistance; (d) A shoulder retractor or harness may be covered when: (A) Erect posture cannot be maintained without support due to lack of motor control or strength; or (B) Has kyphosis; or (C) Presents strong flexor tone; (e) Lateral supports may be covered when a client: (A) Lacks trunk control to maintain lateral stability; or (B) Has scoliosis that requires support; or (C) Needs a guide to find midline; (f) A headrest may be covered when a client: (A) Lacks head control and cannot hold head up without support; or (B) Has strong extensor thrust pattern that requires inhibition; (g) Independent adjustable knee pads may be covered when a client: (A) Has severe leg length discrepancy; or (B) Has contractures in one leg greater than the other; (h) An actuator handle extension may be covered when a client: (A) Has no caregiver; and (B) Is able to transfer independently into standing frame; and (C) Has limited range of motion in arm or shoulder and cannot reach actuator in some positions; (i) Arm troughs may be covered when a client: (A) Has increased tone that pulls arms backward so hands cannot come to midline; or (B) Has poor tone, strength, or control that causes arms to hang out to side and backward causing pain and risking injury; or (C) Has needs for posture; (j) A tray may be covered when proper positioning cannot be accomplished with other accessories; (k) Abductors may be covered to reduce tone for proper alignment and weight bearing; (l) Sandals (shoe holders) may be covered when a client: (A) Has dorsiflexion of the foot or feet; or (B) Has planar flexion of the foot or feet; or (C) Has eversion of the foot or feet; or (D) Has need for safety. (4) If a client has one aid that meets medical needs, regardless of who obtained it, the Division may not provide another aid of same or similar function. (5) Gait Belts (E0700) shall be covered when: (a) The client weighs 60 lbs. or more; and (b) The care provider is trained in the proper use; and (c) The client can walk independently but needs: (A) A minor correction of ambulation; or (B) Minimal or standby assistance to walk alone; or (C) Requires assistance with transfer; (6) For services requiring prior authorization (PA), submit the following documentation to support coverage criteria in this rule are met: (a) Documentation of medical appropriateness, which has been reviewed and signed by the prescribing practitioner; (b) The care plan outlining positioning and treatment regimen and all DME currently available for use by the client; (c) The practitioner’s order; (d) Each item requested shall be itemized with description of product, make, model number, and manufacturers’ suggested retail price (MSRP); (e) The Positioner Justification form (DMAP 3155) or reasonable facsimile with recommendation for most appropriate equipment completed by the prescribing practitioner or the evaluating PT or OT; (7) Providers shall use the appropriate HCPCS code assigned to the standing system base (e.g., E0637, E0638, E0641, and E0642). (8) Providers shall use E1399 for standing frame accessories when billing separately from the base. PA is required when the billed charge for the accessory is greater than $150. (9) PDAC coding verification is not required on standing frame equipment and accessories as this is statutorily excluded from Medicare coverage and as such does not have an assigned HCPCS code. (10) Documentation and medical records to support the client meets all criteria and conditions of coverage in this rule must be kept on file with the DMEPOS provider and shall be made available to the Division upon request. (11) Table 122-0365. [ED. NOTE: To view attachments referenced in rule text, click here to view rule.] Statutory/Other Authority: ORS 413.042 & 414.065 Statutes/Other Implemented: ORS 414.065 History: DMAP 87-2025, amend filed 12/09/2025, effective 12/09/2025 DMAP 12-2024, minor correction filed 01/04/2024, effective 01/04/2024 DMAP 101-2023, amend filed 12/29/2023, effective 01/01/2024 DMAP 11-2016, f. 2-24-16, cert. ef. 3-1-16 DMAP 37-2008, f. 12-11-08, cert. ef. 1-1-09 DMAP 17-2008, f. 6-13-08, cert. ef. 7-1-08 OMAP 47-2006, f. 12-15-06, cert. ef. 1-1-07 OMAP 94-2004, f. 12-30-04, cert. ef. 1-1-05 OMAP 44-2004, f. & cert. ef. 7-1-04 OMAP 25-2004, f. & cert. ef. 4-1-04 OMAP 21-2003, f. 3-26-03, cert. ef. 4-1-03 OMAP 47-2002, f. & cert. ef. 10-1-02 OMAP 32-2001, f. 9-24-01, cert. ef. 10-1-01 OMAP 37-2000, f. 9-29-00, cert. ef. 10-1-00