Medicare FAQ’sMedicare FAQ's

Here are some common questions regarding Medicare Reimbursement.

Will Medicare pay for a Power Wheelchair?
If you qualify, Medicare will pay for a portion of your power wheelchair.

If I qualify, how much will Medicare pay towards the purchase of a power wheelchair?
Medicare will pay 80% of a set allowable for a power wheelchair. The amount depends on the type of power wheelchair you choose.

How do I know if I qualify?
Medicare has certain medical criteria that need to be met before Medicare will pay for a power wheelchair.

Can I find out if I medically qualify before I purchase the Power Wheelchair?
At this time, Medicare offers Advance Determination of Medicare Coverage (Prior Authorization) for certain types of power wheelchairs. The power wheelchairs eligible for this are those that come with a power tilt or power recline seating system or those that come with some type of specialty control device. If your physician prescribes a power wheelchair with one of these options, we can send a request to Medicare to see if you qualify in advance. Medicare will let you know within 30 days if you medically qualify.

Motorized Scooter Reimbursement
Most Scooters or Power Operated Vehicles (POVs) are recognized and qualify for potential reimbursement under Medicare and other Health Care Insurance Companies as a power operated vehicle or (P.O.V.).

If you need a scooter for mobility and you meet your insurance’s coverage guidelines, they may pay for all or part of the cost of the scooter. Coverage criteria and payment amounts will vary depending on the type of insurance you have. Most health care insurance companies, including Medicare, have minimum requirements that need to be met before they will purchase a scooter for you.

Power Operated Vehicles (POVs)/Scooters
Medicare Coverage Criteria
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 of 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, and

The patient must be evaluated with a face-to-face exam by their physician. Some criteria that must be included are: pertinent diagnosis/conditions, upper and lower extremity strength or lack thereof, has the patient tried a least costly alternative? Also required are physical or occupational therapy notes and past medical history which is related to mobility issues.

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.

If you feel you meet these requirements, you may be eligible to receive the most stylish, best performing and most reliable scooter available on the market today at little or no out of pocket.

Here are some common questions regarding Medicare Reimbursement.

Will Medicare pay for a Scooter?
If you qualify, Medicare will pay for a portion of your scooter.

If I qualify, how much will Medicare pay towards the purchase of scooter?
Medicare will pay 80% of a set allowable for a scooter. The amount depends on your state of residence.

How do I know if I qualify?
Medicare has certain medical criteria that need to be met before Medicare will pay for a scooter.

How do I submit a claim to Medicare? What other information needs to be sent?
WestMed Rehab will submit the claim in your behalf after you purchase the scooter. Medicare will process your claim and inform you of their payment decision.

Can I find out if I medically qualify before I purchase the scooter?
No, Medicare does not have a Prior Authorization process available at this time.

Seat Lift Chair Reimbursement
Most Seat Lift Chairs are recognized and qualify for potential reimbursement under Medicare and other Health Care Insurance Companies.

If you need a lift chair and you meet your insurance’s coverage guidelines, they may pay for all or part of the cost of the lift mechanism. Coverage criteria and payment amounts will vary depending on the type of insurance you have. Most health care insurance companies, including Medicare, have minimum requirements that need to be met before they will purchase a lift chair for you.

Seat Lift Chairs
Medicare Coverage Criteria
A seat lift mechanism is covered if all of the following 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 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.

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. Excluded from coverage is the type of lift which operated by spring release mechanism with a sudden, catapult-like motion and jolts the patient from a seated to a standing position. Coverage is limited to the seat lift mechanism, even if it is incorporated into a chair.

If you feel you meet these requirements, you may be eligible to receive the most stylish, best performing and most reliable lift chair available on the market today.

Here are some common questions regarding Medicare

Will Medicare pay for a Seat Lift Chair?
If you qualify, Medicare will pay for a portion of your Seat Lift Chair. The portion that Medicare will pay for is the seat lift mechanism that is incorporated into a Seat Lift Chair.

What is a seat lift mechanism?
The seat lift mechanism is the portion of the lift chair that gently lifts you to a standing position. It includes the metal frame on which the chair rests, the lift motor, the scissors mechanisms and the hand control unit.

If I qualify, how much will Medicare pay towards the purchase of a Seat Lift Chair?
Medicare will pay 80% of a set allowable for a seat lift mechanism. The amount depends on your state of residence. On average the amount reimbursed by Medicare is around $250.00.

How do I know if I qualify?
Medicare has certain medical criteria that need to be met before Medicare will pay for a seat lift mechanism. Medicare requires a Certificate of Medical Necessity, also known as CMN, to be completed by your physician based on your medical condition. Generally, Medicare will only pay for the seat lift mechanism if the patient has a neuromuscular disease or severe arthritis of the hip or knee that completely prevents the patient from standing up from a regular armchair or any chair in their home. Medicare also requires that once standing the patient must have the ability to ambulate. Additionally, the seat lift mechanism must be part of the physician’s course of treatment and be prescribed to effect improvement, or arrest or retard deterioration in the patient’s condition.

How do I submit a claim to Medicare? What other information needs to be sent?
Once you have a completed CMN signed by your physician and after you purchase the Seat Lift Chair, we will submit a claim along with the CMN to Medicare on your behalf. Medicare will process your claim and inform you of their payment decision.