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Questions about Medicare? Call us at 1.800.850.0335

Medicare Billing on SpinLife

SpinLife is an authorized Medicare provider and we are happy to assist you in obtaining reimbursement from Medicare for any eligible item.

We understand that the process of submitting claims to Medicare can be tricky and time consuming. To help make the process easier, SpinLife offers what is known as "courtesy billing." Basically, this means that after you purchase an eligible product from SpinLife and request that we "courtesy bill" Medicare, we will handle all of the documentation required to submit a claim to Medicare on your behalf. This includes any paperwork needed from your physician. If your claim is approved by Medicare, they will reimburse you directly.

Items eligible for Medicare reimbursement are marked with a small M in a green circle: Green Medicare Icon

Need to submit Medicare-related forms to SpinLife? Please fax to: 1-866-716-3278.

Reimbursement Overview

Every product that is eligible for Medicare reimbursement has what is called an "allowable amount." This "allowable" dictates the amount of reimbursement that Medicare will provide product and varies by category and by state.

For eligible items, Medicare will normally pay 80% of this allowable amount. The other 20% is considered the beneficiary’s responsibility.

Because SpinLife’s prices are generally well below the Medicare allowable for eligible products, the 20% that you are responsible for will likely be much lower than with other suppliers. This could mean significant savings on your 20% co-pay.

Please call SpinLife at 1-800-850-0335 to determine the allowable amounts for the any of the item(s) you are interested in purchasing.

Reimbursement Process

After purchasing a Medicare-eligible product and requesting that SpinLife courtesy bill Medicare on your behalf, we will work with you to complete all of the required documentation and submit your claim.

There are several important things to know about the Medicare Reimbursement process:

  1. SpinLife is only able to provide courtesy billing for customers that have non-HMO Medicare as their primary coverage. An HMO is a secondary company whose services have been enlisted to manage your Medicare coverage and benefits.
  2. SpinLife will verify coverage and eligibility before processing your order.
  3. If you request Medicare billing, your product will not ship until we receive all of the required documentation regarding your claim. 

Reimbursement Criteria

In order to be approved for Medicare reimbursement, specific criteria must be met. These criteria vary from category to category. Below is an overview of the criteria used by Medicare to determine eligibility by category.

The following is not all-inclusive. For more information regarding eligibility, please contact 1-800-850-0335 or email customerservice@spinlife.com

Lift Chairs

Medicare only covers the seat-lift mechanism, but not the actual chair itself. The reimbursement amount is roughly $300 depending on the state in which the beneficiary is located if the coverage criteria are met.

A lift chair is considered medically necessary if all of the following coverage criteria are met:

  • The patient 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 patient’s condition.
  • The patient must be completely incapable of standing up from a regular armchair or any chair in their home.
  • Once standing, the patient must have the ability to walk.
  • By Medicare standards, the fact that a patient has difficulty or is even incapable of getting up from a chair, particularly a low chair, is not sufficient justification for a seat lift mechanism. Almost all patients who are capable of ambulating can get out of an ordinary chair, if the seat height is appropriate and the chair has arms. Medicare requires that the physician ordering the seat lift mechanism must be the attending physician or a consulting physician for the disease or condition resulting in the need for a seat lift. 

 

Wheelchair Cushions

For wheelchair cushions, Medicare requires that SpinLife submit the manufacturer, model and the date of purchase of the wheelchair for which the cushion will be used. This information must be submitted along with the prescription in order to submit the claim.  

 

Power Wheelchairs & Scooters

The beneficiary may qualify for reimbursement for a power wheelchair or mobility scooter if the following general criteria are met:

  • The beneficiary must have a mobility limitation which prevents them from performing one or more mobility related activities of daily living in the home, including toileting, eating, bathing, and grooming.
  • There can not be other conditions that limit the beneficiary from performing mobility-related activities of daily living at home, such as significant impairments of cognition or judgment and/or vision. This only applies if these other conditions can not be solved through other means, including caregiver support.
  • The beneficiary must demonstrate the capability and the willingness to consistently operate the device safely.
  • A cane, walker, or manual wheelchair will not provide the necessary functional mobility.
  • The beneficiary’s environment must allow for the use of a power wheelchair or scooter in all areas where the mobility related activities of daily living are customarily performed.
  • For a scooter, the beneficiary must have sufficient strength and postural stability to operate the scooter.
  • For a power wheelchair, the additional features provided by a power wheelchair must be required by the beneficiary in order to perform one or more mobility-related activities of daily living.

Physician Must Have Valid NPI & PECOS Enrollment

Please note: Effective July 1, 2010, in order to be eligible for Medicare reimbursement on any durable medical equipment purchase, your prescribing physician must:

  • Have a valid national provider identifier (NPI).
  • Be enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS).
If your prescribing physician does not have a valid NPI or PECOS enrollment, your claim will be denied. To view a list of physicians and non-physician practitioners who have a valid NPI and PECOS enrollment, you can visit:
http://www.cms.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp and download the PDF document titled "Medicare Ordering and Referring File [PDF]". You can also contact your physician's office for this information.