If you need durable medical equipment in your home, your doctor or treating practitioner (such as a nurse practitioner, physician assistant, or clinical nurse specialist) must prescribe the type of equipment you
need. For some equipment, Medicare also requires your doctor or one of the doctor’s office staff to fill out a special form and send it to Medicare to get approval for the equipment. This is called a Certificate of Medical Necessity. Your supplier will work with your doctor to see that all required information is submitted to Medicare. If your prescription and/or condition changes, your doctor must complete and submit a new, updated certificate.
Medicare only covers durable medical equipment if you get it from a supplier enrolled in the Medicare Program. This means that the supplier has been approved by Medicare and has a Medicare supplier number.
To find a supplier that is enrolled in the Medicare Program, visit www.medicare.gov and select “Find Suppliers of Medical Equipment in Your Area.” You can also call 1-800-MEDICARE (1-800-633-4227) to get this information. TTY users should call 1-877-486-2048.
A supplier enrolled in the Medicare Program must meet strict standards to qualify for a Medicare supplier number. If your supplier doesn’t have a supplier number, Medicare won’t pay your claim, even if your supplier is a large chain or department store that sells more than just durable medical equipment.
Power wheelchairs and scooters
For Medicare to cover a power wheelchair or scooter, your doctor must state that you need it because of your medical condition.
Medicare won’t cover a power wheelchair or scooter that is only needed and used outside of the home.
Most suppliers who work with Medicare are honest. There are a few who aren’t honest. Medicare is working with other government agencies to protect you and the Medicare Program from dishonest suppliers of power wheelchairs and scooters.
For more information about Medicare’s coverage of power wheelchairs or scooters, view the publication “Protecting Medicare’s Power Wheelchair and Scooter Benefit.” Visit www.medicare.gov and select “Find a Medicare Publication.” You can also call 1-800-MEDICARE (1-800-633-4227). TTY users
should call 1-877-486-2048.
Durable medical equipment (DME ) medical billing. How to do billing for Medicare and what equipment covered by Medicare. DME Modifiers and CPT codes.
Tuesday, February 10, 2015
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