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Electric Wheelchairs and Medicare

  • Published: 2009-03-19 : Kent Pinkerton.
  • Synopsis: To obtain Medicare for electric wheelchairs certain criteria have to be met.

Main Document

Electric wheelchairs are very expensive and therefore, it can be a difficult decision whether to buy one. However, Medicare usually covers up to 80% of the cost of electric wheelchairs. Any secondary insurance company will usually cover the rest.

Electric wheelchairs are very expensive and therefore, it can be a difficult decision whether to buy one. However, Medicare usually covers up to 80% of the cost of electric wheelchairs. Any secondary insurance company will usually cover the rest.

To obtain Medicare for electric wheelchairs, certain criteria have to be met:

1. The person's condition is such that, a wheelchair or scooter is a must for mobility.

2. The person cannot operate a manual wheelchair, hence an electric wheelchair or an electric scooter is required.

3. The person is capable of safely operating the controls of a wheelchair or scooter.

4. The person can safely transfer in and out of a wheelchair or scooter.

5. The person has adequate trunk stability to safely ride a wheelchair or scooter.

6. The person has not purchased a wheelchair or scooter and obtained reimbursement for that purchase within the last five 5 years.

7. Medicare must be the primary insurance carrier for filing the initial claim with them.

8. If Medicare had covered the cost of a manual wheelchair previously, that chair should be returned to the company for claiming the cost of an electric wheelchair from Medicare.

If all of these criteria are met, then the person seeking support from Medicare should provide a description of the functional limitations affecting the patient, which supports the medical necessity of the POV; patient diagnosis requiring the POV.

This information must be furnished on letterhead or other documentation, which identifies the specialty of the ordering physician. The recommendation for a wheelchair for which reimbursement is requested needs to be ordered by a neurologist, orthopedic surgeon, rheumatologist, or rehabilitation medicine specialist.

Medicare supports up to 80% of allowable charges however, reimbursement amounts vary from state to state. $100.00 is deductible yearly for Medicare's Part B. All Medicare claims are settled within 30 days. For guaranteed assurance, it is better to fill out a pre-approval form from Medicare.

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