Follow this Simple Medicare Process so Medicare can help with a Lift Chair Reimbursement
You Need to Qualify for Reimbursement the following way:
- You receive the chair with receipt
- Your doctor has given you a prescription because the chair is a medical necessity
- You filled out form CMS -849
- Send Prescription, receipt and form 849 into Medicare office for reimbursement
Steps for Medicare Payment
Our aim is to make this a simple process. The bottom line is you will qualify for Medicare reimbursement if you meet the following:
Step 1 – Your doctor has given you a prescription because the chair is a medical necessity. Your doctor should be part of the Provider Enrollment Chain and Ownership System. You can just ask your doctor, or you can go to the National Provider Identifier website to find out. (most health providers are part of the program)
If you are really interested in getting some more information on the process that your health care provider had undertaken there is some information at the PECOS website.
Step 2-You filled out form 849, which is the form for medical necessity, your health care provider can help you with any details. Down load your copy of the certificate of Medical necessity Click here for form. Fill out this form, (once again) if you need any help answering any of the parts please discuss with your healthcare provider. They should be able to help you. You can also download the form here – LiftMechanismFormCMS-849 508 01_2020
If you are interested in further information, it can be found at Center for Medicare and Medicaid Services It is important to understand the definition of “medically necessary.” Your doctor will only give you a prescription if he/she deems you as such. Medicare can help with a lift chair purchase thru reimbursement program.
If you fit these conditions you will qualify for rebate from the government through Medicare.
- Severe Arthritis in your hip or knee, or a severe neuromuscular disease. (your doctor determines this when they give you a prescription)
- The seat lift mechanism is part of the treatment plan from your doctor, in other words it will help the condition by stopping or slowing down the condition.
- Your condition prevents you from standing up and you would be confined to a chair or bed without the lift chair equipment
- The device operates smoothly, you can control the device and you can sit and stand without additional help.
- You must be able to walk once you get into a standing position. You can walk with a cane, or walker. (your doctor will determine because it is possible to still qualify if your condition has improved and you are not able to walk with a walker or cane.)
Who doesn’t qualify
- Those who do not have Medicare part B
- If you are in a skilled nursing facility
- You are in the hospital
- Medicare paid for a manual or powered wheelchair
- Medicare paid for a scooter
- The lift chair is a spring- release mechanism (does not operate smoothly)
- Your doctor has not deemed that a lift chair is medically necessary
How much does Medicare pay
The motorized portion of the lift recliner is the part covered by Medicare. If you qualify for the government program, Medicare, may cover up to 80% of the amount for the motor. So, Medicare will reimburse you for up to 80% of the “seat lift mechanism”. The seat lift mechanism is the mechanical part of the chair. This does not include the upholstery, armrest and cushions.
To find out what portion of the lift chair you selected is considered motorized send an email question to the chair provider.
Here is sample text
(feel free to cut and paste this portion into your email message, PLEASE change the XXXX to actual amounts based on the stand-up chair you are interested in purchasing)
| Email Message to Lift Stand Up Chair Provider |
To Name of company,
I am considering purchasing your Model XXXX lift recliner chair. This chair sales price is $XXXXX I am qualified for Medicare reimbursement and I need to know what portion of your chair is considered “seat lift mechanism”.
Please provide this amount in dollars. (as opposed to percentage) And within 48 hours so that I may start my purchase process.
The maximum allowable payment for Durable Medical Equipment is determined by the state. Below is a chart which tells you the maximum for the state at the time of publishing this article. No States below are part of the competitive bidding program for lift chairs.
Please check with the Medicare office to ensure that there are no changes.
|State Abbreviations||Maximum Amount Reimbursed|
|AL, CO, CT, FL, MT, NC, ND, NH, GA, ID, IL, KY, MA, ME, MN, MO, OR, RI, SC, SD, TN, UT, VA, VT, WY,||$321.75|
|AZ, CA, DC, DE, NJ, NM, NV, OH, MD, MI, MS, OK, PA, TX, WA, WI, WV||$315.44|
|AR, NE, IA, LA||$314.98|
How much time
When you have submitted your claim and it has been filed, you can expect a response within 60 days. They will do one of three things; 1.) send you a check or 2.) ask for missing information or 3.) tell you why it was denied. If you follow the instructions included in this article you should be well prepared to insure you receive payment.
So, that is it, if you have any questions please drop us a note we will be looking out to see how we can help get you an answer. Are there any other steps that we missed? Let me know.