Wheelchair Coverage PrecautionsIn order for Medicare to cover 80\% of the approved amount you must make sure that you have established the following:
Medicare Part B
You must have Medicare Part B Coverage. Medicare Part B covers outpatient (outside of the hospital) health expenses like doctors' visits, supplies and equipment. Part A covers inpatient hospital expenses. If you do not have Medicare Part B your wheelchair purchase or rental will not be covered.
Your doctor will deem a wheelchair medically necessary if it allows you to live more independently, helping you to do daily activities such as: bathing, going to the bathroom, getting out of bed, dressing or moving about the house.
You must have a written prescription for the wheelchair from your doctor before you purchase or rent a wheelchair. Without one your wheelchair purchase or rental will not be covered by Medicare.
Your medical supplier must accept assignment from Medicare. This means that it contracts with Medicare and agrees not to charge more than the predetermined Medicare amount. Every supply or piece of equipment has a preapproved amount or price. This price is the amount on which Medicare bases its 80 percent coverage. Prices vary by category and state. If the equipment supplier is not contracted with Medicare you are entirely responsible for the cost of the wheelchair.
What Constitutes Medical Necessity?A doctor will assess your medical need for a wheelchair by using the following criteria:
You are unable to walk even with help from other walking aids such as a cane or walker.
You would be bed-ridden or confined to a chair if you did not have a wheelchair.
You are able to function the wheelchair properly and able to transfer in and out of the chair safely.
The chair will help you become more independent inside the home.