Medicare Reimbursement

Medicare requirements change frequently but have more recently become more stringent. The following information is provided as a courtesy only. It is the customer's responsibility to verify the accuracy of the information.

Scooters

A prescription
A Certificate of Medical Necessity (CMN)
* Medicare requests that the physician ordering a scooter be one of the following specialists: Physiatrist, Orthopedist, Neurologist or Rheumatologist

In order to fill out the CMN for a scooter and be considered medically necessary, the following coverage criteria must all be met:

The patient is unable to operate a manual wheelchair within his or her residence and would otherwise be confined to bed.
The patient is capable of safely operating the controls for the scooter.
The patient can transfer safely in and out of the scooter, and have adequate trunk stability for safety.
The patient's condition must be such that a POV is required for the patient to get around WITHIN his or her residence. A POV that is beneficial primarily in allowing the patient to perform leisure or recreational activities will be denied as a non medically necessity.

Power Chairs

A prescription
A Certificate of Medical Necessity (CMN)
*Medicare requests that the physician ordering a scooter be one of the following specialists: Physiatrist, Orthopedist, Neurologist or Rheumatologist

In order to fill out a CMN for an electric wheelchair and be covered the following criteria must be met:

The patients condition is such that without the use of a wheelchair the patient would be bed or chair confined, and
The patient's condition is such that a wheelchair is medically necessary and the patient is unable to operate a manual wheelchair.
The patient is capable of safely operating the controls of a power wheelchair.
The patient requires the use of a wheelchair to move around their residence.
The patient has severe weakness of the upper extremities due to a neurological, muscular, or cardiopulmonary disease or condition.
The patient's condition is such that a power wheelchair will be needed long term.
The patient's condition is such that without the use of a wheelchair would be bed or chair confined.
Because part of Medicare criteria is that the patient be unable to operate a manual wheelchair, if Medicare has previously covered the rental of a manual wheelchair, the manual wheelchair must be returned to the company that supplied it before Medicare will cover the cost of an electric wheelchair.

Lift Chairs

A prescription
A Certificate of Medical Necessity (CMN)

For lift chairs, Medicare will only cover the seat lift mechanism, but not the actual chair itself. The reimbursement amount is roughly $320 depending on the state in which the patient is located. A lift chair would 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
Once standing, the patient must have the ability to walk.

By Medicare standards, 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. Medicare requires that the physician ordering the seat lift mechanism must be the attending physician or a consulting physician for the disease or condition resulting in the need for a seat lift.