MEDICARE COVERED?

Medicare Covered Mobility Scooters, Lift Chairs, Power Wheelchairs, Power-Operated Vehicle (POV)

Information on: Medicare coverage, insurance reimbursement, payment criteria for durable medical equipment (DME), prostheses & prosthetic devices, orthotics & supplies.

Unfortunately, EasyMedOnline no longer bills Medicare for any products.

IMPORTANT: Medicare now has a rental program for mobility scooters, power wheelchairs, hospital beds and some other mobility / assistive products (DME).

Please Note: Medicare will not cover lift chairs, mobility scooters, power wheelchairs and other mobility devices if the patient is in a hospital, rehab facility, skilled nursing facility, or nursing facility.

Competitive bidding: Now, in many areas, called competitive bidding areas, you must acquire certain mobility devices from a select group of suppliers chosen by Medicare. If you are outside of the competitive bid areas you will need to find a dealer who will still bill Medicare (call Medicare at 1-800-633-4227 to locate a provider).


The top questions we get on what Medicare will, or will not do for DME:

What is the lightest mobility scooter that’s medicare approved and pay for?

Its very hard to get Medicare to approve any scooter these days never mind the lightest.

Can I pick the power wheelchair I want from Medicare?

You may be able to pick the type of wheelchair but many times you get what medicare gives you.

Will Medicare pay for a wheelchair carrier or electric lift (vehicle lift)?

As far as we know medicare has not supplied a wheelchair carrier or electric lift for standard power wheelchairs or scooters.

Will Medicare pay for a lift chair?

The last we heard they pay a few hundred dollars for just the lift mechanism part of the chair.


Below is the current information from Medicare criteria for mobility devices …

Qualifying & Medicare Reimbursement / Payment Criteria for a New Lift Chair

Medicare covers the seat lift mechanism portion of the new lift chair. The reimbursement amount is about $290 depending your location.

Medicare patient and doctor requirements for a lift chair:

• The patient has severe arthritis of the hip or knee, or has a severe neuromuscular disease.

• The lift mechanism should be part of the physician’s course for treatment.

• The lift mechanism would be prescribed for improvement, or arrest or retard deterioration in the patient’s condition.

• The patient is not capable of standing up from an armchair or any chair at home.

• Once standing, the patient needs to have the ability to walk.

(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.)

Qualifying & Medicare criteria for mobility scooter or electric wheelchair coverage (POV):

Now there are much stricter guidelines for doctors and providers who evaluate the patient for a POV. The evaluation is even more lengthy and detailed.

As of January 1, 2011, Medicare beneficiaries can only rent the equipment over a 13-month period. When the 13-month rental period has expired, the supplier will transfer ownership to the beneficiary.

If your doctor submits a written order stating that you have a medical need for a wheelchair or scooter for use in your home, Medicare will help cover any of the types listed below. Generally, Medicare will pay 80% of the Medicare-approved amount, after you have met the Part B deductible. You pay 20% of the Medicare approved amount. Wheelchairs (both manual and power) and scooters are also known as “mobility assistive equipment.”

• The patient is unable to operate a manual wheelchair.

• The patient is not be able to move around in their home using a wheelchair.

• The patient is able to safely operate the controls for the POV.

• The patient is able safely transfer into and out of the POV.

• The patient has adequate trunk stability in order to be safely drive the POV.

• A physician who orders the scooter is one of the following specialties: Orthopedic Surgery, Physical Medicine, Rheumatology or Neurology.

• Medicare will not re-reimburse for a POV if its not a medical necessity.

• Medicare will not re-reimburse for a POV if it is only used outside the home.

Qualifying for a Manual Wheelchair

If you can’t use a cane or walker safely, you may qualify for a manual wheelchair. The manual wheelchair you choose can’t be a high strength, ultra-lightweight wheelchair that you could buy without renting first.

Qualifying for a Rolling Chair/Geri-chair

If you need more support than a wheelchair can give, you may qualify for a rolling chair. These chairs have small wheels that are at least 5 inches in diameter. The rolling chair must be designed to meet your medical needs due to illness or other impairment.

If you can’t use a cane or walker, or can’t operate a manual wheelchair, you may qualify for a power-operated scooter. Power Wheelchair

If you can’t use a manual wheelchair in your home, or if you don’t qualify for a power-operated scooter because you aren’t strong enough to sit up or to work the scooter controls safely, you may qualify for a power wheelchair. Before you get either a power wheelchair or scooter, you must have a face-to-face exam by your doctor. The doctor will review your needs and help you decide if you can safely operate the device. If so, the doctor will submit a written order telling Medicare why you need the device and that you’re able to operate it. Remember, you must have a medical need for Medicare to cover a power wheelchair or scooter. Medicare won’t cover this equipment if it will be used mainly for leisure or recreational activities, or if it’s only needed to move around outside your home. Also, in some areas, you may need to get your power wheelchair or scooter from specific suppliers approved by Medicare. Visit medicare.gov/supplier or call 1-800-MEDICARE (1-800-633-4227) for more information. TTY users should call 1-877-486-2048.

Note: If you don’t need a power wheelchair or scooter on a long-term basis, you may want to rent the equipment to lower your costs. Talk to your supplier to find out more about this option. Some wheelchairs must be rented first, even if you eventually plan to buy them.

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