Medicare Billing for Wheelchairs & More 

Chi-Chester's Homecare and Medicare

Thanks for shopping at Chi-Chester's Homecare., a full service medical equipment supplier. Chi-Chester's Homecare is an authorized Medicare provider, and we are happy to assist you in obtaining reimbursement from Medicare for any eligible item(s).

Medicare normally pays 80% of an allowable amount, which varies by state and product category. Generally, Chi-Chester's Homecare prices are well below the allowables for most eligible products, meaning that you would likely be reimbursed at 80% of the price. Therefore, our discounted prices can save you significantly on your 20% co-pay. Please call us at (478) 743-4557 or (866) 515-4557 to determine the allowable amounts for the any of the item(s) you are purchasing.

Medicare courtesy billing for Scooters, Lift Chairs, Walkers & Cushions:

For most items, including most scooters, cushions, lift chairs, and walkers we provide what is known as "courtesy billing", also called "non-assigned" billing. Courtesy billing means you purchase the equipment from us and we handle all of the paperwork to submit a claim to Medicare on your behalf. This includes any paperwork needed from your physician. If Medicare approves your claim, Medicare will reimburse you directly.

Lift Chairs

For lift chairs, Medicare will only cover the seat lift mechanism, but not the actual chair itself. The reimbursement amount is roughly $300 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.

Wheelchair Cushions

For wheelchair cushions, Medicare requires that we submit the manufacturer, the model, and the date of purchase of the wheelchair. Please send in this information along with the prescription.

Medicare billing for Power Wheelchairs and many Scooters:

For many power wheelchairs and scooters, Chi-Chester's Homcare provides what is called "assigned billing", where we can handle all of the paperwork with your physician, provide the requested equipment and then bill Medicare and a secondary insurer if applicable. You would only pay the co-pay and any annual deductible you may have (with secondary insurance). Medicare will reimburse us directly for the power wheelchair or scooter, and you may have little to no out-of-pocket cost. Please call our customer service department at (478) 743-4557 or (866) 515-4557and talk to a Medicare specialist about purchasing a power wheelchair and billing Medicare. Our specialists will determine over the phone if you may be eligible, and can help you to select the power chair or scooter that is right for you.

What to expect

(new procedures implemented by Medicare on 10/25/2005)
If you are purchasing a scooter or a power wheelchair you will speak with a Chi-Chester's Homecare, customer service team member regarding your specific circumstances and to gather information regarding eligibility. The process involves these simple steps:

• Step 1. Call (478) 743-4557 or (866) 515-4557 and ask to talk to a Medicare Specialist. Our specialist will ask you a series of questions to help determine if a scooter or power wheelchair will meet your needs and if you may be eligible for Medicare coverage. We will also ask you some basic questions about your home to determine what time of mobility equipment can be used safely inside the home.
• Step 2. The next step is a visit with your physician. We will e-mail, fax or mail you a packet to take with you when your visit your physician.
• Step 3. Your physician will perform an assessment to determine your power mobility needs, and if appropriate, will write a prescription and make appropriate notes in your chart. If the doctor does not feel comfortable completing the assessment, they may refer you to an occupational or physical therapist. If a therapist completes the evaluation a copy will be provided to your physician to place in your chart.
• Step 4. The physician will mail or fax the prescription, along with supporting assessment forms and chart notes, to us. This information MUST be received by Chi-Chester's Homecare within 30 days of when your prescription and assessment are complete. We will also ask you to email, fax, or mail us a copy of your Medicare card.
• Step 5. A Chi-Chester's Homecare Medicare expert will review the paperwork for accuracy and completeness. Within three business day of when your paperwork is received, our Medicare specialists will contact you to further discuss your prescription and information. If the information meets Medicare's coverage criteria we will collect the co-pay and deliver your scooter or power wheelchair as soon as possible, usually within 5 business days.

Power Wheelchair and Scooter Coverage Criteria

The beneficiary may qualify for a power wheelchair or scooter if the following general criteria are met:

• The beneficiary must have a mobility limitation which prevents them from performing one or more mobility related activities of daily living in the home, including toileting, eating, bathing, and grooming.
• There can not be other conditions that limit the beneficiary from performing mobility-related activities of daily living at home, such as significant impairments of cognition or judgment and/or vision. This only applies if these other conditions can not be solved through other means, including caregiver support.
• The beneficiary must demonstrate the capability and the willingness to consistently operate the device safely.
• A cane, walker, or manual wheelchair will not provide the necessary functional mobility.
• The beneficiary's environment must allow for the use of a power wheelchair or scooter in all areas where the mobility related activities of daily living are customarily performed.
• For a scooter, the beneficiary must have sufficient strength and postural stability to operate the scooter.
• For a power wheelchair, the additional features provided by a power wheelchair must be required by the beneficiary in order to perform one or more mobility-related activities of daily living.