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Medicare and Seat Lift Chairs

 
 

Understanding Medicare's Coverage Criteria for a Seat Lift Chair

A seat lift chair (mechanism) is covered if all of the following criteria are met:

  • The beneficiary 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 beneficiary's condition.
  • The beneficiary must be completely incapable of standing up from a regular armchair or any chair in their home.
  • Once standing, the beneficiary must have the ability to ambulate.

Important Medicare Rules for Seat Lift Chairs

Before you can take delivery of your new seat lift chair, your physician must write an order (prescription) or complete the Certificate of Medical Necessity (instructions below) for the seat lift chair.

The order must contain:

  1. Beneficiary's name
  2. Physician's name
  3. Date of the order
  4. Detailed description of the item (i.e. Seat Lift Chair)
  5. Physician signature and signature date

The patient's physician must complete a portion of the Certificate of Medical Necessity (CMN). The completed CMN can serve as both the order and CMN is completed prior to delivery.

INSTRUCTIONS FOR COMPLETING THE CERTIFICATE OF MEDICAL NECESSITY FOR A SEAT LIFT CHAIR (MECHANISMS) - CMS-849 Form

SECTION A: (May be completed by the beneficiary)

CERTIFICATION: Mark "INITIAL" and indicate the date of the prescription in this space.

PATIENT INFORMATION: Indicate the patient's name, permanent legal address, telephone number. Indicate patient's Medicare number as it appears on his/her Medicare card and on the claim form.

SUPPLIER: Indicate the name of the company, address and telephone number. Indicate NA for the Medicare Supplier Number.

PLACE OF SERVICE: Indicate the place in which the item is being used (i.e., patient's home is 12)

FACILITY NAME: Leave blank

HCPCS CODES: List HCPCS codes for items purchased. Seat Lift Chair HCPCS code is E0627

PATIENT INFORMATION: Indicate patient's date of birth (MM/DD/YY) and sex (male or female); height in inches and weight in pounds, if requested.

PHYSICIAN INFORMATION: Indicate the PHYSICIAN'S name and complete mailing address. Indicate the physician's Unique Physician Identification Number (UPIN) - UPIN number can be obtained from your physician's office.

Indicate the telephone number where the physician can be contacted (preferably where records would be accessible pertaining to this patient) if more information is needed.

SECTION B: (MUST be completed by the ordering physician)

The physician needs to indicate the estimated length of need (the length of time the physician expects the patient to require use of the ordered item) by filling in the appropriate number of months. If the patient will require the item for the duration of his/her life, then enter "99".

The physician needs to indicate the ICD-9 code(s) that represents the primary reason for ordering this item.

QUESTION SECTION: This section is used to gather clinical information to help Medicare determine the medical necessity for the item(s) being ordered. Only the physician can answer each question which applies to the items ordered, circling "Y" for yes, "N" for no, or "D" for does not apply.

If a clinical professional other than the treating physician (e.g. nurse) or a physician employee answers the questions of Section B, he/she must print his/her name, give his/her professional title and the name of his/her employer where indicated. If the physician is answering the questions, this space may be left blank.

SECTION C: (May be completed by the beneficiary)

Provide a narrative description of the item(s) ordered - Seat Lift Chair

Provide the charge (amount you paid) for each item and the Medicare fee schedule allowance for the state in which the patient resides. (See table below)

2013 Medicare Allowable for E0627 - Seat Lift Chair

  • AK
    $361.64
  • AL
    $365.23
  • AR
    $357.53
  • AZ
    $358.07
  • CA
    $358.07
  • CO
    $365.23
  • CT
    $365.23
  • DC
    $358.07
  • DE
    $358.07
  • FL
    $365.23
  • GA
    $365.23
  • HI
    $386.69
  • IA
    $357.54
  • ID
    $365.23
  • IL
    $365.23
  • IN
    $344.80
  • KS
    $360.45
  • KY
    $365.23
  • LA
    $357.53
  • MA
    $365.23
  • MD
    $358.07
  • ME
    $365.23
  • MI
    $358.07
  • MN
    $365.23
  • MO
    $365.23
  • MS
    $358.07
  • MT
    $365.23
  • NC
    $365.23
  • ND
    $365.23
  • NE
    $357.53
  • NH
    $365.23
  • NJ
    $358.07
  • NM
    $358.07
  • NV
    $358.07
  • NY
    $356.22
  • OH
    $358.07
  • OK
    $358.07
  • OR
    $365.23
  • PA
    $358.07
  • PR
    $429.65
  • RI
    $365.23
  • SC
    $365.23
  • SD
    $365.23
  • TN
    $365.23
  • TX
    $358.08
  • UT
    $365.23
  • VA
    $365.23
  • VI
    $356.22
  • VT
    $365.23
  • WA
    $358.07
  • WI
    $358.07
  • WV
    $358.07
  • WY
    $365.23
 

SECTION D: (To be completed by the physician)

The physician's signature certifies the CMN which he/she is reviewing includes Sections A, B, C and D and the answers in Section B are correct. After completion and/or review by the physician of Sections A, B and C, the physician's must sign and date the CMN in Section D, verifying the Attestation appearing in this Section. The physician's signature also certifies the items ordered are medically necessary for this patient.

HOW TO FILL OUT THE MEDICARE CMS-1490S FORM

CMS-1490S (English) - CMS-1490S (Spanish)

Medicare will pay you directly when you complete this form and attach an itemized bill from the company where you purchased the equipment.

FOLLOW THESE INSTRUCTIONS CAREFULLY:

Block 1. Print your name shown on your Medicare Card (Last Name, First Name, Middle Name).

Block 2. Print your Medicare Number including the letter at the end exactly as it is shown on your Medicare card.

Check the appropriate box for the patient's sex.

Block 3. Furnish your mailing address and include your telephone number in Block 3b.

Block 4. Describe the condition/medical reason for which you purchased the equipment. Check the appropriate box in Blocks 4b and 4c.

Block 5a. Complete this Block if you are age 65 or older and enrolled in a health insurance plan where you are currently working.

Block 5b. Complete this Block if you are age 65 or older and enrolled in a health insurance plan where your spouse is currently working.

Block 5c. Complete this Block if you have any medical coverage other than Medicare. Be sure to provide the Policy or Medical Assistance Number. You may check the box provided if you do not wish payment information from this claim released to your other insurer.

Block 6. Be sure to sign your name. If you cannot write your name, make an (X) mark. Then have a witness sign his or her name and address in Block 6 too.

If you are completing this form for another Medicare patient you should write (By) and sign your name and address in Block 6. You also should show your relationship to the patient and briefly explain why the patient cannot sign.

Block 6b. Print the date you completed this form.

Include an itemized bill that shows all of the following information:

Each itemized bill MUST show all of the following information:

  • Date of purchase for each item
  • Place of purchase for each item
  • Description of each item furnished
  • Charge for EACH item
  • Make and manufacturer of the item purchased
  • HCPCS code (if available) Seat Lift Chair HCPCS code is E0627

WHERE TO SEND THE CLAIM (INCLUDE A COPY OF THE COMPLETED CMN AND THE ITEMIZED BILL)

If you live in: Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont

Return your form to:

NHIC, Corp.
P.O. Box 9165
Hingham, MA 02043-9165

If you live in: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin

Return your form to:

National Government Services, Inc.
DMEPOS Operations
Medicare DMEPOS Claims
P.O. Box 7027
Indianapolis, IN 46207-7027

If you live in: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, West Virginia

Return your form to:

CIGNA Government Services
P.O. Box 20010
Nashville, TN 37202-0010

If you live in: Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, Wyoming

Return your form to:

Noridian Administrative Services
P.O. Box 6727
Fargo, ND 58108-6727

Position on a Patient's Right to Purchase Durable Medical Equipment (DME) from a Non-Medicare Company and be Reimbursed by Medicare provided Medicare Coverage Criteria and Guidelines are met

Updated: July 1, 2013

ABSTRACT

This document provides information and supporting documentation on the ability of a Medicare beneficiary to purchase Durable Medical Equipment (i.e. Seat Lift Chair) from a non- Medicare enrolled business and submit a claim to Medicare for reimbursement provided Medicare coverage criteria and guidelines have been met.

BACKGROUND

Providers of Durable Medical Equipment (DME) who are enrolled as a Medicare provider must, by law 1, submit a claim to Medicare on behalf of a Medicare beneficiary for the DME provided. Companies that sell DME and are not enrolled as a Medicare provider are not bound by the Medicare provider requirements are not required, by law, to submit a claim to Medicare on behalf of the Medicare beneficiary.

Disclosure

Companies that are not enrolled in the Medicare program must inform Medicare beneficiaries prior to delivery of the item that they are not enrolled as a Medicare provider and cannot bill Medicare for the item provided. This will allow the beneficiary to make an informed consumer decision on whether or not to receive the item(s) for which he or she may have to pay for "out-of-pocket."

SUMMARY

When a company that is not enrolled in the Medicare program as an approved Medicare provider sells Durable Medical Equipment (DME) to Medicare beneficiaries, the company is required to inform the Medicare beneficiary prior to delivery of the item that they are not enrolled and cannot bill Medicare for the item provided. After the beneficiary is informed of this information and makes an informed consumer decision to purchase the item of DME from the non-enrolled company, a claim may be submitted by the beneficiary to the Medicare contractor that will process, and pay for covered services submitted by beneficiaries on a CMS-1490S Form 2.

DISCLAIMER:
Please be advised, we are not a Medicare Provider. If you purchase items from us that you feel are covered under under Medicare, please use the above procedures to file your claim for allowable reimbursement.
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