medicare criteria

Criteria for Medicare Coverage

Medicare Liaison Service:

The Medicare qualification process can be confusing and time-consuming. That's why Medical Travel, Inc. has in-house Medicare experts who will take your information and accurately determine whether or not you qualify for Medicare reimbursement. If you do qualify, we'll even complete your paperwork for no additional charge!

The following questions will help you determine whether or not you'd like us to seek Medicare reimbursement for your scooter or power chair.

Is your upper body weak?
Is your upper body weakness caused by a neurological (nervous system) problem, muscular condition or heart disease?
Are you seeing one or more of the following types of doctors: physical medicine, orthopedic surgeon, neurologist or rheumatologist?
Does your medical condition require you to utilize a wheelchair? In other words, do you need a wheelchair to move around your house?
Without your wheelchair, would you be confined to a bed or chair?
Are you unable to operate your wheelchair manually?
Do you believe you can safely operate the controls of a power wheelchair?
Do you believe that your medical condition will require you to use a power wheelchair or scooter for at least six months?

Did you answer "Yes" to every question? If so, please call us toll free at 1-800-778-7953 and ask to talk to a Medicare liaison.

Medicare will deny a scooter as not medically necessary when it is needed only for use outside the home. A scooter that is beneficial primarily in allowing the patient to perform leisure or recreational activities will be denied as not medically necessary.

Power Wheelchairs:

A power chair could be considered medically necessary by Medicare when all of the following coverage criteria are met:

The patient's condition is such that without the use of a wheelchair the patient would be bed or chair confined; and,
The patient's condition is such that a wheelchair is medically necessary and the patient is unable to operate a wheelchair manually; and
The patient is capable of safely operating the controls of a power wheelchair.
The patient requires the use of a wheelchair to move around in their residence
The patient has severe weakness of the upper extremities due to a neurological, muscular, or cardiopulmonary disease or condition
The patient's condition is such that a power wheelchair will be needed long term (at least six (6)months).

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.