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How do I obtain Medicare coverage for medical equipment I need in the home?
In most cases a Doctor's written prescription (Rx) is all that is required, or Dispensing Order written by the treating physician. Some items require a Detailed Written Order (DWO) prior to delivery or a Certificate of Medical Necessity (CMN)
A Dispensing Order (prescription) must include:
A description of the item
The beneficiary's full name
The date of order; and
Physician's signature and date
A Written Order must include:
Detailed description of the item and accessories
The beneficiary's full name
An ICD-9-CM diagnosis code
Start date of the order
The length of need
Physician's signature and date
Begin Processing Medicare Claim
What do you need to begin processing your Medicare claim?
Once you have placed your order you can fax or email us the following information:
Full legal name of patient, address, phone number.
Full name, FAX number and UPIN of prescribing doctor. (Ask doctor for their UPIN number)
Doctor's prescription for desired equipment, which must include patient's diagnosis.
Patient's Medicare number, which must include the alpha character after the number (A, B, D, etc).
Patient's date of birth.
Patient's height & weight.
Medicare Assignment and Non-Assignment Billing
What does "assigned" and "non-assigned" mean?
"Assigned" means the supplier accepts the Medicare-approved fee for the equipment. Medicare pays for 80% of the approved fee. The beneficiary is responsible for the remaining 20%. "Non-assigned" means the beneficiary pays the supplier in full for the equipment and the supplier submits the claim to Medicare. If the item is covered, Medicare reimburses the beneficiary 80% of the approved fee.
What is Covered by Medicare?
Medicare Part B helps pay for durable medical equipment, including;
manual wheelchairs (capped rental)
some positioning devices
walkers , rollators
seat-lift mechanisms for lift-chairs
mattress over-lays (capped rental)
hospital beds, semi-electric type only (capped rental)
oxygen equipment (capped rental)
Durable medical equipment, such as wheelchairs, are covered only when prescribed by a doctor and the coverage criteria is meet. You can find out what equipment is covered, and whether a supplier is approved, by calling Medicare's durable medical equipment (DMERC) regional carrier for your area. We are an approved supplier.
Products Not Covered by Medicare
What is NOT covered by Medicare?
Equipment not covered by Medicare includes; adaptive daily living aids such as: ramps, automobile lifts, reachers, sock-aids, utensils, transfer benches, shower chairs, raised toilet seats, adjustable based beds , pulse oximeter and grab bars. Basically, Medicare stops at the bathroom door. For more detailed information regarding coverage, call 1-800-MEDICARE.
What is covered in a nursing home or skilled nursing facility?
Under Part A, orthotics and durable medical equipment are not covered.
Under Part B, only orthotics can be covered. If you are about to be discharged from a nursing home or skilled nursing facility, medical equipment can be delivered two days prior to discharge to allow the staff and family to learn how to use the equipment.
Coverage for your Home
What is considered, Home?
Home medical equipment must be appropriate for use in the home. Your "home" is your house, assisted living facility, apartment, a relative's home, or a group home in which you live. However, certain facility's are NOT CONSIDERED YOUR HOME: a hospital, skilled nursing facility, or nursing facility.
What does capped rental mean?
For the majority of products covered by Medicare, 80% of the rental is covered for 13 continuous months of use. Most secondary insurers pick up the remaining 20%.
Products covered as capped rental of 13 months:
Some Support Surfaces such as Low-Air-Loss and Alternating Pressure mattress.
After Medicare has paid for 13 months of continuous use, the supplier may transfer the title to the beneficiary.
Adjustable Bed Coverage
Does Medicare pay or reimburse for Adjustable Beds?
Medicare coverage for a bed is limited to a Semi-Electric Hospital Bed
and all hospital beds are covered as a capped rental only. Medicare does not cover Adjustable Beds.
Hospital Bed Coverage
Does Medicare pay or reimburse for Hospital Beds?
Medicare covers hospital beds
as a Capped Rental item. This means that you must use a vendor in your local area that rents equipment and bills Medicare for the monthly fees. Your local dealer will install and maintain this "capped rental" equipment. Medicare does not
consider a full-electric hospital bed, Adjustable Bed, or other Luxury beds to be medically necessary. Medicare coverage is for a Semi-electric twin-size hospital bed
See all Hospital Beds
Are Overbed or Bedside Tables covered by Medicare?
Over-Bed Tables an Bedside Tables are not classified as a medical necessity and are not covered.
Are Transfer Boards covered by Medicare?
Transfer boards may be considered medically necessary for patients with medical conditions that limit their ability to transfer from wheelchair to bed, chair, or toilet.
Patient Lift Coverage
Are Patient Lifts covered by Medicare?
Patient Lifts are reimbursed as a capped rental item. This means that you must visit a local dealer/retailer that rents such equipment and bills Medicare for the monthly fees. Medicare reimburses 80% of rental for up to 13 months. This capped-rental coverage is for a standard hydraulic-manual lift and sling. Power Lifts and Standing Lifts are not covered.
Are Stand-up Patient Lifts covered by Medicare?
No. Patient Lift coverage is for a Manual/Hydraulic Patient Lift only.
See Patient Lift Catalog
Power Wheelchair Coverage
What is Medicare's coverage criteria for motorized or power wheelchairs?
Medicare may pay for a motorized wheelchair. Although it is not guaranteed that you will qualify or be reimbursed by Medicare, whether you personally lay out the price for one, or are looking for Medicare to purchase one for you, we can give you some guidelines to follow and the basic criteria that must be met in order for Medicare to either reimburse or authorize payment for a motorized unit.
A power wheelchair is covered when all of the following criteria are met:
The patient's condition is such that without the use of a wheelchair the patient
would otherwise be bed or chair confined.
The patient's condition is such that a wheelchair is medically necessary and the
patient is unable to operate a wheelchair manually.
The patient is capable of safely operating the controls for the power wheelchair
A patient who requires a power wheelchair
usually is totally non-ambulatory and has severe weakness of the upper extremities due to a neurological or muscular disease/condition. If the documentation does not support the medical necessity of a power wheelchair but does support the medical necessity of a manual wheelchair, payment is based on the allowance for the least costly medically appropriate alternative. However, if the power wheelchair has been purchased, and the manual wheelchair on which payment is based is in the capped rental category, the power wheelchair will be denied as not medically necessary. Options that are beneficial primarily in allowing the patient to perform leisure or recreational activities are non-covered. See all Power Wheelchairs
Power Scooter Coverage
What is Medicare's coverage of power operated Vehicles (POVs) or scooters?
A power operated vehicle (POV) is covered when all of the following criteria are met:
The patient's condition is such that a wheelchair is required for the patient to get around in the home.
The patient is unable to operate a manual wheelchair.
The patient is capable of safely operating the controls for the POV.
The patient can transfer safely in and out of the POV and has adequate trunk stability to be able to safely ride in the POV.
Most POVs are ordered for patients who are capable of ambulation within the home but require a power vehicle for movement outside the home. POVs will be denied as not medically necessary in these circumstances. A POV that is beneficial primarily in allowing the patient to perform leisure or recreational activities will be denied as not medically necessary. If a Mobility Scooter
is covered, a wheelchair provided at the same time or subsequently will usually be denied as not medically necessary.
See all Power Scooters
Lift Chair Coverage
Will Medicare pay for a Lift Chair?
Only the seat lift mechanism on a Lift Chair could be considered medically necessary if all of the following coverage criteria are met:
The patient must have severe arthritis of the hip or knee or have a severe neuromuscular disease.
The seat lift mechanism must be a part of the physician's course of treatment and be prescribed to effect improvement, or arrest or retard deterioration in the patient's condition.
The patient must be completely incapable of standing up from a regular armchair or any chair in their home. (The fact that a patient has difficulty or is even incapable of getting up from a chair, particularly a low chair, is not sufficient justification for a seat lift mechanism. Almost all patients who are capable of ambulating can get out of an ordinary chair if the seat height is appropriate and the chair has arms.)
Once standing, the patient must have the ability to ambulate (walk).
Coverage of seat lift mechanisms is limited to those types which operate smoothly, can be controlled by the patient, and effectively assist a patient in standing up and sitting down without other assistance. Coverage is limited to the seat lift mechanism, even if it is incorporated into a chair. Medicare reimbursement is approximately $275.00. Read more about Medicare reimbursement criteria for Lift Chair
or shop our Lift Chair Catalog
Does Medicare cover Wheelchair Lifts and Ramps?
Medicare does not reimburse nor authorize the purchase of mobility lifts
for a wheelchair or scooter at this time. Such items are typically not considered a medical necessity because they can also be used by persons without a medical condition.
See all Wheelchair and Scooter Ramps
Do I have to pay the 20% co-payment to Medicare?
After you have met your deductible, you're still responsible for paying directly, or through supplemental insurance, at least 20 percent of the Medicare approved amount. This co-payment may not be dropped by the supplier except in hardship situations and only on a case-by-case basis. A supplier who routinely drops the co-payment may be violating federal law.
Additional Medicare Information and Resources:
official web site at cms.hhs.gov
Medicare at cms.hhs.gov
Medicare.gov — the official website for people with Medicare
Official Medicare publications at Medicare.gov — includes official
publications about current Medicare benefits
Medicare & You handbook for 2009 at Medicare.gov — includes information
about current Medicare benefits
Information about the 1-800-MEDICARE helpline from Medicare.gov — a 24X7
toll-free number to call with questions about Medicare
Medicare Modernization Act at Medicare.gov
Medicare Plan Choices at Medicare.gov — basic information about plan choices
for Medicare beneficiaries, including MA Plans
Prescription Drug Coverage homepage at Medicare.gov — a central location for
Medicare's web-based information about the Part D benefit
MyMedicare.gov — Medicare's secure online service where beneficiaries can
access their own personal Medicare information
medical equipment and Medicare coverage
Medicare pov Power
Medicare mobility scooter
Medicare's Wheelchair and Scooter Benefit
Medicare codes bariatric products by invacare
Durable Medical Equipment
Certificate of Medical Necessity - Seat Lift Mechanism
Invacare Bariatric Products
Scooter Medicare Coverage
Medicare allowable for powerchairs and scootersServing the Entire Phoenix Metropolitan area, including: Chandler Gilbert Glendale Mesa Peoria Scottsdale Tempe Surprise Apache Junction Avondale Buckeye Casa Grande El Mirage Eloy Florence Fountain Hills Goodyear Maricopa Paradise Valley Queen Creek