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803-796-7840

1060 Chris Drive Suite D

West Columbia, SC 29169

FAQ

Frequently Asked Questions

How do I obtain insurance coverage for medical equipment I need in the home?

A Dispensing Order written by the treating physician must be sent to us before an item can be supplied. Some items require a Detailed Written Order (DWO) prior to delivery or a Certificate of Medical Necessity (CMN).

A Dispensing Order (prescription) must include:

  • A description of the item
  • The beneficiary’s full name
  • The date of order
  • Physician’s signature and date

A Written Order must include:

  • Detailed description of the item and accessories
  • The beneficiary’s full name
  • An ICD-9-CM diagnosis code
  • Start date of the order
  • The length of need
  • Physician’s signature and date
What items are covered by Medicare?

Medicare Part B helps pay for durable medical equipment, including:

  • manual wheelchairs (capped rental item)
  • power wheelchairs
  • nebulizers (capped rental item)
  • walkers, rollators, canes, crutches
  • scooters (POV’s)
  • seat-lift mechanisms for lift-chairs
  • mattress over-lays (capped rental item)
  • hospital beds, semi-electric type only (capped rental item)
  • patient lifts (capped rental item)
  • CPAP & BiPAP therapy
  • oxygen equipment (capped rental item)

Durable medical equipment, such as wheelchairs, are covered only when prescribed by a doctor and the coverage criteria is meet. For most of the above equipment there are specific criteria that must be met. Please call to understand the criteria for Medicare coverage.

What does capped rental mean?

Medicare will pay for the rental of the equipment for 13 continuous months of use with the exclusion of oxygen equipment which rents for 36 months. After Medicare has paid for 13 months of continuous use on capped rental equipment, the supplier shall transfer the title to the beneficiary. Oxygen equipment does not transfer title to the beneficiary and the supplier is required to maintain the equipment until the 60th month under Medicare guidelines. After the 60th month the beneficiary can opt for new equipment and a new 36 month rental period begins.

Does Medicare pay or reimburse for a hospital bed?

Medicare considers hospital beds as a “capped rental” item. This means that Medicare will rent the bed for 13 monthly payments after which it will “cap out” and the beneficiary will own the bed. Medicare does not consider a full-electric hospital bed, deluxe bed, or a luxury bed to be medically necessary. If your physician feels a hospital bed is medically necessary, they must chart in the patient notes that they feel it is necessary and the reason why it is necessary verses a traditional bed.

Does Medicare pay or reimburse for a wheelchair?

Medicare considers wheelchairs as a “capped rental” item. This means that Medicare will rent the wheelchair for 13 monthly payments after which it will “cap out” and the beneficiary will own the wheelchair. Medicare does not consider a lightweight, ultra-lightweight, heavy duty, or modified chair medically necessary without doctors notes that support the medical need for such add-ons. If your physician feels a wheelchair is medically necessary, they must chart in the patient notes that they feel it is necessary and the reason why it is necessary verses a cane, walker or crutch.

What is Medicare's coverage criteria for motorized or power wheelchairs?

A power wheelchair may be covered when all of the following criteria are met:

  • The patient’s condition is such that without the use of a wheelchair the patient would otherwise be bed or chair confined.
  • The patient’s condition is such that a wheelchair is medically necessary and the patient is unable to operate a scooter(POV), wheelchair, walker, cane or crutch in their home.
  • The patient is capable of safely operating the controls for the power wheelchair.

A patient who requires a power wheelchair usually is totally non-ambulatory and has severe weakness of the upper extremities due to a neurological or muscular disease/condition. If the documentation does not support the medical necessity of a power wheelchair it will be denied as not medically necessary. For the correct steps to see if you qualify a power wheelchair please call us for a free guide.

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HAVE MORE QUESTIONS?

Give us a call today and we would be glad to assist you.

803-796-7840

Palmetto Home Medical

1060 Chris Drive, Suite D

West Columbia, SC 29169

Phone:  (803) 796-7840

Fax: (803) 796-7846

HOURS

Monday – Friday

9:00 AM – 5:00 PM 

Saturday

Closed

Sunday

Closed

© 2015 Palmetto Home Medical. All rights reserved. 1060 Chris Drive, Suite D | West Columbia, SC | Phone: 803.796.7840