Medicare Coverage Summary
Listed below are some examples of medical equipment covered by Medicare if a patient meets the medical criteria. All equipment listed requires a physician’s order.
Canes & Crutches
The patient has a mobility limitation that impairs his/her ability to participate in mobility-related activities of daily living, and the mobility deficit can be sufficiently resolved by the use of a cane or crutch.
The patient is physically incapable of using regular toilet facilities, i.e., confined to a single room, confined to one level of the home without a toilet on that level, and/or confined to a home without toilet facilities.
A fixed-height hospital bed is covered if the patient has one or more of the following: a medical condition which requires positioning of the body in ways not feasible with an ordinary bed; patient requires positioning to alleviate pain; patient requires traction equipment that can only be attached to a hospital bed; patient requires the head of the bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration and pillows or wedges have been tried and ruled out. Variable height, semi-electric, and heavy-duty beds require specific medical conditions. Fully electric beds are not covered.
Lift Chairs (Seat Lift Mechanism)
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 to effect improvement or retard or arrest deterioration in the patient’s condition; the patient must be completely incapable of standing up from any chair in the home and, once standing, must be capable of ambulation.
The patient’s medical condition requires the use of a lift to transfer between a bed, chair, wheelchair, or commode and, without the use of a lift, would be bed confined.
Pressure Reducing Support Surfaces
Group 1 – Alternating Pressure Pad: One of the three following criteria must be met: the patient is (a) completely immobile, i.e., unable to change body position without assistance, (b) the patient has any stage pressure ulcer on the trunk or pelvis, or (c) the patient cannot independently change body position enough to alleviate pressure. In addition to (b) and (c) above, in order to qualify under (c), the patient must also have either impaired nutrition, fecal or urinary incontinence, altered sensory perception, or compromised circulation.
Group 2 – Low Air Loss Therapy and Group 3 – Air Fluidized Bed: Very specific conditions and medical justification are required to support reimbursement. Please call our office for more information regarding these support surfaces.
Power Wheelchairs & Power Operated Vehicles (Scooters)
All of the following are required: (a) Face-to-face evaluation by the prescribing physician; (b) detailed written order dated within 45 days of the face-to-face evaluation and (c) extensive chart notes specifically referencing the mobility exam and a complete history and current report of the patient’s condition necessitating the power equipment. The report must also include a physical examination relevant to mobility needs (such as a cardiopulmonary, musculoskeletal, and neurological exam). The physician may also conduct a limited evaluation and write an order for a physical or occupational therapist to conduct a more detailed mobility assessment.
More complex (rehab) power chairs require additional documentation and the involvement of a specialist in wheelchair seating and positioning. Please contact our office for additional information.
Patient must have a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living such as toileting, meals, dressing, grooming, and bathing within the home and the mobility limitation cannot be sufficiently resolved by the use of a cane or walker. There are additional requirements to qualify for hemi-height, lightweight, high-strength, ultra-light, and heavy-duty wheelchairs. The physician must also conduct a face-to-face exam.
Wheelchair Cushions & Specialty Backs
Medical records must contain sufficient documentation to support the medical necessity for a specialty cushion on a wheelchair ordered concurrently or previously on record with Medicare. Cushions for transport chairs are not reimbursed.
Patient has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living in the home and the functional mobility deficit can be sufficiently resolved with the use of a walker.