Lift Chair & Medicare

Are you a senior citizen who wants to know about Medicare and medical lift chairs? “Seat lift chairs,” what Medicare calls lift chairs, are covered under a range of items called Durable Medical Equipment (DMO) which are apart of Medicare Party B.

If you have Medicare, Medicare can reimburse you for a purchase of a lift chair if you meet certain requirements. The reimbursement is never for the full cost of the chair as it only covers 80% of the cost of the lift mechanism (the mechanical part of the chair such as the motor and levers and not the “chair” part of the chair such as the seat, back, cushions, upholstery, armrest, and legs). This part is also called a “seat lift.”

For DME, individuals on Medicare part B must buy their equipment from Competitive Bidding Suppliers if they live in a Competitive Bidding Zone. Luckily for lift chair buyers, seat lift mechanisms are in the Non-Competitive Bid category. This means that individuals can buy lift chairs from any supplier, online or offline, and receive a rebate, regardless if they live in a Competitive Bidding Area or not.

This article will help you understand Medicare guidelines, requirements, billing, and coverage for power lift chairs.

 

How to get a Medicare reimbursement check for a lift chair seat lift mechanisms.

Here are the steps and requirements to getting approved for a Medicare reimbursement.

1. 

   Double check to make sure your physician has a valid National Provider Identifier (NPI) and is enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS). Only NPI and PECOS physicians can write prescriptions that are covered by Medicare.

   You can check by typing in your physician’s name in http://www.oandp.com/pecos/.

2. Make sure you are on Medicare part B.
3. You have a prescription from your physician for a lift chair.
4. You meet the following 4 criteria that determines if a lift chair is a medical necessity:
   A. You have severe arthritis in your knee or hip or you have a neuromuscular condition.
   B. The lift chair must be apart of a course of treatment and is prescribed to arrest, retard, or improve your condition.
   C. You must be unable to stand up from a regular arm chair or any chair in your home.
   D. When you stand, you are able to walk.
5. Download the CMS-849 “Certificate of Medical Necessity” form, also known as the Lift Chair Medicare Form or Reimbursement Form, fill it out and have your physician fill it out.
6. Go to your local Medicare office with your CMS-849, prescription, and lift chair receipt.

How much is Medicare’s lift chair recliner reimbursement?

Medicare will only reimburse for the lifting mechanism of the lift chair (the motor and levers). The reimbursement is only for 80% of the lifting mechanism. The remaining 20% of the lifting mechanism and the chair itself will not be reimbursed. Reimbursement is capped at different amounts for different stated. Below is the maximum for each state (and Puerto Rico).

State	Max Reimbursement	State	Max Reimbursement
AK	318.59	MT	321.75
AL	321.75	NC	321.75
AR	314.98	ND	321.75
AZ	315.44	NE	314.98
CA	315.44	NH	321.75
CO	321.75	NJ	315.44
CT	321.75	NM	315.44
DC	315.44	NV	315.44
DE	315.44	NY	313.82
FL	321.75	OH	315.44
GA	321.75	OK	315.44
HI	340.66	OR	321.75
IA	314.99	PA	315.44
ID	321.75	PR	378.51
IL	321.75	RI	321.75
IN	303.75	SC	321.75
KS	317.54	SD	321.75
KY	321.75	TN	321.75
LA	314.98	TX	315.45
MA	321.75	UT	321.75
MD	315.44	VA	321.75
ME	321.75	VI	313.82
MI	315.44	VT	321.75
MN	321.75	WA	315.44
MO	321.75	WI	315.44
MS	315.44	WV	315.44
		WY	321.75

How long will it take to get my reimbursement?

Once your claim has been filed, Medicare will respond in 45 to 60 days. They will either give you your reimbursement check or explain why your request was denied.