Tuesday, June 5, 2007

Mobility and Medicare: A Practical Guide, Part II

Last week we discussed the guidelines Medicare uses when considering coverage for electric scooters and power wheelchairs. This week, we will look at the process for purchasing canes and walkers through Medicare.

As you saw last time with the series of questions the physician must respond to when charting your case, Medicare will cover the equipment needed for mobility related aids for daily livings (MRADLs). If a cane or walker will respond to the need, Medicare will cover the appropriate one and not a manual wheelchair or power operated vehicle.

The critical documentation needed before you can obtain a cane or walker is a written, dated and signed order by the physician. You must present that order to the provider of the cane or walker, although a faxed copy will often suffice. The key is that this order must be dated BEFORE the purchase. At Capabilities, we do complimentary billing for Medicare, so you will typically pay for your cane or walker up front and we will submit the billing to Medicare.

As with the case of power operated vehicles, however, the physician’s records must reflect why you are in need of a mobility device. A clear diagnosis must be included in this documentation. Our billing office is in contact with the physician’s office to complete the documentation required before the claim can be submitted.

Be advised that Medicare has reimbursable limits for each item. In the case of a cane, for example, that reimbursement is $21.07. This amount usually represents only a percentage of the true price of a cane. A quad cane (with a four-pronged base) has a slightly higher allowable of $47.55. (Remember that these are current figures and are subject to change.)

Walkers are slightly more complex as there are many varieties. Medicare is most likely to cover a standard walker, or a standard walker with wheels, typically 3-inch or 5-inch wheels. There are rare circumstances when Medicare will cover a “rolling walker,” the type with four wheels, a seat and hand brakes. If your physician believes this is the only type of walker that will work with your condition, s/he will have to be very specific about the condition and why this is the only option. As with canes, the order must be written, dated and signed by your physician. We need the order in hand before we can sell you the piece of equipment.

It’s important to keep in mind that once Medicare covers one piece of mobility equipment, there must be a significant change in condition for Medicare to approve another claim for more mobility equipment. There are, of course, conditions whose symptoms progress dramatically, and in these cases the diagnosis and medical chart will clearly reveal the need.

Check future blogs for more information about Medicare.

Please email us or post your questions or comments regarding Medicare in general or if you have a specific question.

1 comment:

Anonymous said...

Thanks for the important information. It really helped us be prepared when we needed to get a walker for my Mom.