Lift Chairs

Medicare only covers the seat-lift mechanism, but not the actual chair itself. The reimbursement amount is roughly $300 depending on the state in which the beneficiary is located if the coverage criteria are met.

A lift chair is 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.

Your physician must complete a Certificate of Medical Necessity (CMN) in order for you to be eligible for Medicare reimbursement for a lift chair.

Wheelchair Cushions

For wheelchair cushions, Medicare requires that Mr. Mobility™ submit the manufacturer, model and the date of purchase of the wheelchair for which the cushion will be used. This information must be submitted along with the prescription in order to submit the claim.

Power Wheelchairs & Scooters

The beneficiary may qualify for reimbursement 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 or walker are not sufficient to resolve the mobility limitation.
• The beneficiary's medical condition prevents them from self-propelling a manual wheelchair to accomplish mobility related activities of daily living.
• 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.

This letter from Medicare's medical directors outlines exactly what your physician must document in order for you to be eligible for reimbursement for a power chair or scooter.

In order to courtesy bill Medicare for power wheelchairs and scooters, Mr. Mobility MUST receive all medical necessity documentation from your physician before the equipment is delivered to you.