A Dispensing Order written by the treating physician must be sent to us before an item can be supplied. 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 Written Order must include:
Medicare Part B helps pay for durable medical equipment, including;
Durable medical equipment, such as wheelchairs, are covered only when prescribed by a doctor and the coverage criteria is meet. For most of the above equipment there are specific criteria that must be met. Please call to understand the criteria for Medicare coverage.
3. What does capped rental mean?Medicare will pay for the rental of the equipment for 13 continuous months of use with the exclusion of oxygen equipment which rents for 36 months. After Medicare has paid for 13 months of continuous use on most capped rental equipment or 36 months on oxygen equipment, the supplier shall transfer the title to the beneficiary.
4. Does Medicare pay or reimburse for Hospital Beds?Medicare considers hospital beds as a "capped rental" item. This means that Medicare will rent the bed for 13 monthly payments after which it will "cap out" and the beneficiary will own the bed. Medicare does not consider a full-electric hospital bed, deluxe bed, or a luxury bed to be medically necessary. If your physician feels a hospital bed is medically necessary, they must chart in the patient notes that they feel it is necessary and the reason why it is necessary verses a traditional bed.
5. Are manual wheelchairs covered by Medicare?Medicare considers wheelchairs as a "capped rental" item. This means that Medicare will rent the wheelchair for 13 monthly payments after which it will "cap out" and the beneficiary will own the wheelchair. Medicare does not consider a lightweight, ultra-lightweight, heavy duty, or modified chair medically necessary without doctors notes that support the medical need for such add-ons. If your physician feels a wheelchair is medically necessary, they must chart in the patient notes that they feel it is necessary and the reason why it is necessary verses a cane, walker or crutch.
6. Is Respiratory Equipment covered by Medicare?Oxygen Concentrators, CPAP and other respiratory products are Capped Rentals thru Medicare. These items are also considered capped rental items and have specific criteria for coverage:
(OSA) documented by an attended, facility-based polysomnogram and it confirms that significant apneas & hypnopneas are occuring
7. Medicare covers equipment for "home use". 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 home: a hospital, skilled nursing facility, or nursing facility.
8. Are walkers and rollators covered?Medicare will allow a walker/rollator every 5 years with documentation that the current walker is unusable.
9. What is Medicare's coverage criteria for motorized or power wheelchairs?A power wheelchair may be covered when all of the following criteria are met:
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 it will be denied as not medically necessary. For the correct steps to see if you qualify a power wheelchair please call us for a free guide.
10. What is Medicare's coverage of power operated Vehicles (POVs) or scooters?A power operated vehicle (POV) or scooter is covered when all of the following criteria are met:
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.
11. Does Medicare cover Lift Chairs?Only the seat lift mechanism on a lift chair could be considered medically necessary if all of the following coverage criteria are met:
Coverage is limited to the seat lift mechanism, even if it is incorporated into a chair. The Medicare allowable for a Seat-lift Mechanism is approximately $340.00
12. Does Medicare cover Wheelchair Lifts and Ramps?Medicare does not reimburse nor authorize the purchase of a lift 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. Don't forget, Medicare covers items needed "inside" the residence.
13. 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.
14. Does Medicare cover bath safety items such as shower chairs, transfer benches, grab bars, raised toilet seats, etc...?Medicare does NOT cover bath safety items. Medicare coverage stops at the bathroom door.
15. Does Medicare cover oxygen for patients that travel?No. If a beneficiary travels out of their supplier's usual service area, it is the beneficiary's responsibility to arrange for oxygen during their travels. Medicare will only pay one supplier for oxygen during any one rental month.
Oxygen services furnished by an airline to a beneficiary are noncovered. Payment for oxygen furnished by an airline is the responsibility of the beneficiary and not the responsibility of the supplier.