Medicare Billing for Wheelchairs & More

SpinLife and Medicare
Thanks for shopping at SpinLife, a full service medical equipment supplier. SpinLife is an authorized Medicare provider, and we are happy to assist you in obtaining reimbursement from Medicare for any eligible item(s). Items eligible for Medicare reimbursement are marked on the SpinLife website with a small M in a green circle, like this:

Medicare normally pays 80% of an allowable amount, which varies by state and product category. Generally, SpinLife prices are well below the allowables for most eligible products, meaning that you would likely be reimbursed at 80% of the SpinLife price. Therefore, our discounted prices can save you significantly on your 20% co-pay. Please call SpinLife customer service at 1-800-850-0335 to determine the allowable amounts for the any of the item(s) you are purchasing.

SpinLife is only able to process claims 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. SpinLife will verify your coverage and eligibility before processing your order.

Medicare courtesy billing for Power Wheelchairs, Ultralightweight Wheelchairs, Scooters, Lift Chairs, Walkers and Cushions:

Lift Chairs

For lift chairs, Medicare will only cover the seat lift mechanism, but not the actual chair itself. The reimbursement amount is roughly $300 depending on the state in which the patient is located. A lift chair would be 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, the model, and the date of purchase of the wheelchair. Please send in this information along with the prescription.

Power Wheelchair and Scooter Coverage Criteria

The beneficiary may qualify for a power wheelchair or 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.