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In broad terms, Medicare has 4 main parts. Part A is Hospital Insurance, Part B is Medical Insurance, Part C encompasses Medicare Advantage or ‘Medicare Replacement’ Plans and Part D is Prescription Drug Coverage. In general, most medical equipment and supplies will fall under Medicare’s Part B Coverage.

To meet Medicare’s criteria for coverage on most medical equipment and supplies, you will need a prescription from your physician.  At a minimum, the prescription should include these elements:  1. Patient Name 2. Item Prescribed 3. Diagnosis Of Why The Item Is Needed (ICD-10 Codes) 4. Length Of Need or How Long The Item Will Be Needed (In some cases, this will determine if Medicare will rent or purchase the item) 5. Physician’s Signature 6. Date The Item Was Prescribed. 

In addition to the prescription, the physician should document in the patient’s chart notes the need for the item being prescribed and why.  The fact that a physician wrote a prescription for an item does not automatically mean it will be covered by Medicare.  Each item, whether it is a walker, hospital bed, manual wheelchair, or cane has its own coverage criteria that must be met for Medicare to consider payment.  Lincoln Mobility and its experienced staff can help you determine if a prescribed item will be covered by Medicare.

For example, to meet coverage criteria for a standard walker, here is the coverage criteria a physician must document for a patient:

1. The beneficiary has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living (MRADL) (toileting, feeding, dressing, grooming, and bathing) in customary locations in the home. A mobility limitation is one that: a. Prevents the beneficiary from accomplishing the MRADL entirely, or b. Places the beneficiary at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform the MRADL, or c. Prevents the beneficiary from completing the MRADL within a reasonable time frame; and 2. The beneficiary is able to safely use the walker; and 3. The functional mobility deficit can be sufficiently resolved with use of a walker. 

If ALL of the criteria are not met, the walker will be denied as NOT Medically Necessary.  

If you have questions about whether or not an item will be covered by Medicare, contact a professional at Lincoln Mobility at 402-421-8800, visit them at 2655 S. 70th Street in Lincoln, Nebraska, or on the web at www.LincolnMobility.com

 

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