is an authorized Medicare provider and we are happy to assist you in obtaining
reimbursement from Medicare for eligible mobility scooters, lift chairs, rolling
walkers and wheelchair cushions. Items eligible for Medicare reimbursement are
marked with this icon: . Please note:
SpinLife does not provide courtesy billing for Medicaid.
take the time to look through common questions you might have about Medicare
billing below. If you need additional help, please call our Medicare specialists
understand that the process of submitting claims to Medicare can be difficult
and time consuming. To help make the process easier, SpinLife offers what is
known as "courtesy billing". This means that after you purchase an eligible
product from SpinLife and request at checkout that we courtesy bill Medicare, we
handle all of the documentation required to submit a claim to Medicare on your
behalf. If your claim is approved by Medicare, they will reimburse you directly
for their portion of your claim.
note the following important information about Medicare courtesy billing:
assigns every product that is eligible for reimbursement what is called an
"allowable amount". The allowable amount is the maximum amount that Medicare
will consider as the total price of the item. The allowable amount for each item
varies slightly by state. Medicare will pay 80% of the allowable amount or 80%
of the cost of the item from SpinLife, whichever is less. The other 20%, or
copay, is the beneficiary’s responsibility.
SpinLife’s prices are generally well below the Medicare allowable amount for
eligible products, your 20% copay will likely be less than what it would be if
you purchased from a local medical equipment supplier. This could mean
significant savings on your 20% copay. Here are allowable amounts for items
commonly purchased on SpinLife:
Chair Mechanisms (HCPCS Code
The allowable range is between $250-$300. View a
state-by-state reimbursement chart.
cushions that provide skin protection and/or positioning (HCPCS Code
The allowable ranges from $250 - $350 for standard sizes, depending on the
specific cushion you choose.
Please note the following important information about Medicare reimbursement
applicable deductibles must be met before Medicare will reimburse you for their
portion of the allowable amount on an approved claim.
we can't guarantee Medicare reimbursement, we can promise that we’ll work with
you to ensure that claims will be filed accurately and completely.
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courtesy billing for scooters available in my area?
In most areas, yes.
However, residents of California, Florida, Illinois, Michigan, New York, North
Carolina and Texas will need prior authorization from The Centers for Medicare
and Medicaid (CMS) before we can ship your scooter. Here’s why:
September 1, 2012, for residents of CA, FL, IL, MI, NY, NC and TX: The
Centers for Medicare and Medicaid (CMS) implemented a Prior Authorization (PA)
process for scooters for people with Fee-For-Service Medicare who reside in
seven states with high populations of fraud- and error-prone providers. The PA
process does not disqualify you from reimbursement; it just changes the
procedure for billing and delivery. Therefore, if you live in these states we
will not be able to ship your product until we send all the necessary paperwork
to Medicare and they respond to us with the authorization to proceed. For more
information, see "Fact Sheet: General Information" (PDF).
are unable to courtesy bill Medicare if the beneficiary resides in a Competitive
Bid Area (CBA). The ZIP codes included in each CBA are posted on the Competitive
Bidding Implementation Contractor (CBIC) web site: http://dmecompetitivebid.com/palmetto/cbic.nsf/DocsCat/Home
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does the reimbursement process work?
purchasing a Medicare-eligible product and requesting that SpinLife bill
Medicare on your behalf, we will work with you to complete the required
documentation and submit your claim.
the basic process:
1:: We will send you the three documents listed below, which you must
read and sign. You may provide your electronic signature online during the
checkout process or via the Medicare email that you receive from SpinLife. You
may also choose to print, sign and return these documents to SpinLife via fax or
2: We will ask you to submit the following information to SpinLife:
prescription from your physician for all Medicare eligible equipment. This
prescription must have a date that is before the date your product is delivered.
copy of your Medicare Card, both front and back
date of birth
lift chairs only, please have your physician fill out the Certificate of
Medical Necessity (CMN) document, which we will provide. This document must be
signed/dated within 30 days of the written RX date, and can be returned to
SpinLife by either the physician's office or by you.
For mobility scooters only, you will schedule a face-to-face
Functional Mobility Examination with your physician. Full details of the
process are provided in the Medicare packet which we will provide.
For cushions only, the manufacturer name, model number, serial number
and date of purchase of the wheelchair already on file with Medicare for which
the cushion will be used
3: After all information is received, including the information
required by your physician, SpinLife will file your claim with Medicare within
4: Medicare will process your claim. Medicare has between 45-60 days to
respond to you regarding your claim and if your claim is approved, you will
receive reimbursement directly from Medicare.
Note: SpinLife cannot provide courtesy billing for customers that have
an HMO Medicare Advantage Plan as their primary coverage (such as Secure
Horizons HMO or Humana HMO). An Advantage HMO is a Medicare replacement HMO
program whose services have been enlisted to manage your Medicare coverage and
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you bill HMO Medicare Advantage Plans like Secure Horizons or Humana?
cannot provide courtesy billing for customers that have an HMO Medicare
Advantage Plan as their primary coverage (such as Secure Horizons HMO or Humana
HMO). An Advantage HMO is a Medicare replacement HMO program whose services have
been enlisted to manage your Medicare coverage and benefits.
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is the reimbursement criteria for mobility scooters?
beneficiary may qualify for reimbursement for a mobility scooter (also called
power operated vehicles or POVs) if the following general criteria are met:
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.
cannot 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 cannot be addressed through other means, including caregiver
beneficiary must demonstrate the capability and the willingness to consistently
operate the device safely.
cane, walker, or manual wheelchair will not provide the necessary functional
mobility for mobility related activities inside the home.
beneficiary’s environment must allow for the use of scooter in all areas where
the mobility related activities of daily living are customarily performed.
a scooter, the beneficiary must have sufficient strength and postural stability
to operate the scooter.
will deny a scooter as not medically necessary when it is needed only for use
outside the home. A scooter that is beneficial primarily in allowing the
beneficiary to perform leisure or recreational activities will be denied as not
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is the reimbursement criteria for lift chairs?
only covers the seat-lift mechanism, but not the actual chair/furniture portion
itself. The reimbursement amount is between $250-$300 depending on the
chart) 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:
beneficiary must have severe arthritis of the hip or knee, or have a severe
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 must be completely incapable of standing up from a regular armchair or
any chair in their home.
standing, the patient must have the ability to walk, even if a cane, walker or
other assistance is required. Medicare will not cover this item if the
beneficiary has a wheelchair, scooter, or power wheelchair on file.
By Medicare standards, the fact that a beneficiary 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 beneficiaries who are
capable of ambulating can get out of an ordinary chair, if the seat height is
appropriate and the chair has arms.
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.
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is the reimbursement criteria for wheelchair cushions?
wheelchair cushions, the wheelchair for which the cushion will be used must
already be on file with Medicare.
When courtesy billing for the corresponding cushion, Medicare requires
to submit the manufacturer, model
and the date of purchase of the wheelchair on file. If no wheelchair is on file
with Medicare, a cushion and wheelchair can be billed at the same time. The
beneficiary must also either have a current pressure sore or have a previous
history of a pressure sore on record due to the fact that Medicare will not
cover any preventative items. Documentation of positioning requirements and any
other risk factors will also be taken into consideration and should be submitted
to SpinLife with the prescription.
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you bill Medicare for a power wheelchair?
cannot courtesy bill Medicare for power wheelchairs (also called power mobility
devices) because Medicare only provides coverage for power wheelchairs on a
rental basis, and SpinLife does not provide rental equipment. If you rent a
power wheelchair from a local dealer, you will pay a monthly copay of 20% of the
monthly rental amount. There is no guarantee that you will receive new
equipment, nor can you specify a choice of the brand or model that you prefer.
After 13 months of continuous rental, the item is then "purchased" for the
beneficiary by Medicare and no additional copay is required.
SpinLife only sells new equipment and does not provide rentals, we cannot
provide courtesy billing on power wheelchair rentals. Many consumers choose to
purchase their own power chair to guarantee that they receive new product
instead of used product, and that they get the exact product they want. Talk to
one of our product specialists about finding the perfect new chair to meet your
specific needs, and about our financing options. We currently offer 6 months
with no payments and no interest through BillMeLater.
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you bill Medicare for a manual wheelchair, hospital bed, or patient
Lightweight K0005 Manual Wheelchairs are products that can be purchased by
Medicare. If you choose to purchase your ultra-lightweight wheelchair from
SpinLife, we will be happy to assist you in filing for courtesy Medicare
billing. When ordering or filling out a quote simply select “courtesy Medicare
billing.” SpinLife will send you a packet of Medicare documents explaining the
necessary steps to file with Medicare for reimbursement. SpinLife can send this
packet to you electronically or by mail.
only sells new equipment and does not provide rentals, therefore we are unable
to bill Medicare for products that qualify as rental items. Standard
wheelchairs, lightweight wheelchairs, hospital beds and patient lifts are
considered rental items. They require a monthly copay of 20% of the monthly
rental amount. After 13 months of continuous rental, the item is then
“purchased” for the beneficiary and no additional copay is required.
consumers choose to purchase the items they need from SpinLife because our
purchase price is often comparable to the 20% copay they would be required to
pay over a 13 month rental period to a local dealer. Purchasing from SpinLife
also guarantees that you will receive new items instead of used, and that you
will get the exact product you want.
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can I find out if my physician has a valid NPI and PECOS enrollment?
note: Effective July 1, 2010, in order to be eligible for Medicare reimbursement
on any durable medical equipment purchase, your prescribing physician must:
a valid national provider identifier (NPI).
enrolled in the Medicare Provider Enrollment, Chain and Ownership System
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
this government website and download the PDF document titled Medicare Ordering and Referring File [PDF]. You can also
contact your physician's office for this information.
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Information Required by Medicare
Information (Medicare requires that we provide this information)
product sold by our company carries a warranty which can range from 6 months to
more than 5 years. SpinLife honors all manufacturer warranties, and will provide
replacement parts, free of charge, for Medicare-covered equipment that is under
warranty. In addition, an owner’s manual with warranty information will be
provided to beneficiaries for all equipment where this manual is available.
Capped Rental (Medicare requires that we provide this information)
Rental Items are items where Medicare will pay a monthly rental fee for a period
not to exceed 13 months, after which the ownership of the equipment is
transferred to the Medicare beneficiary and it is the beneficiary’s
responsibility to arrange for any required equipment service or repair. Examples
of this type of equipment include hospital beds, alternating pressure pads,
air-fluidized beds, nebulizers, suction pumps, continuous airway pressure (CPAP)
devices, patient lifts and trapeze bars.
Inexpensive or Routinely Purchased items Notification (Medicare
requires that we provide this information)
or routinely purchased items include Lift Chair seat lift mechanisms, canes,
walkers, crutches, commode chairs, low pressure and positioning equalization
pads, home blood glucose monitors, pneumatic compressors (lymphedema pumps), bed
side rails, and traction equipment. These items can be purchased or rented,
although the total amount paid for monthly rentals cannot exceed the fee
schedule purchase amount.
does not provide rentals and does not provide most of these items with the
exception of lift chair seat lift mechanisms. If you would like to rent a lift
chair instead of purchasing your lift chair, SpinLife can direct you to a local
Medical Equipment dealer who can provide a rental product.
SpinLife bill Medicaid for my items?
SpinLife cannot provide courtesy billing for Medicaid. We can only courtesy bill
Medicare or private insurance.