Additional Purchase Option for Electric Wheelchairs -

Effective May 1, 1991, suppliers must give beneficiaries entitled to electric wheelchairs the option of purchasing them at the time the supplier first furnishes the item. Contractors make no rental payment for the first month for electric wheelchairs until the supplier notifies the contractor that it has given the beneficiary the option of either purchasing or renting. Information contained in Exhibit 2 may be furnished to beneficiaries by suppliers to help them make a rent/purchase decision. Contractors provide copies of Exhibit 2 to suppliers. Payment must be on a lump-sum fee schedule purchase basis where the beneficiary chooses the purchase option. If the beneficiary declines to purchase the electric wheelchair initially, contractors make rental payments in the same manner as any other capped rental item, including the instructions in §30.5.2.


Exhibits

Exhibit 1 - The Rent/Purchase Option

You have been renting your (specify the item(s) of equipment) for 10 continuous rental months. Medicare requires (specify name of supplier) to give you the option of converting your rental agreement to a purchase agreement. This means that if you accept this option, you would own the medical equipment. If you accept the purchase option, Medicare continues making rental payments for your equipment for 3 additional rental months. You are responsible for the 20 percent coinsurance amounts and, for unassigned claims, the balance between the Medicare allowed amount and the supplier's charge. After making these additional rental payments, title to the equipment is transferred to you. You have until (specify the date one month from the date the supplier notifies the patient of this option) to elect the purchase option. If you decide not to elect the purchase option, Medicare continues making rental payments for an additional 5 rental months, a total of 15 months. You are responsible for the 20 percent coinsurance amounts and, for unassigned claims, the balance between the Medicare allowed amount and the supplier's charge. After a total of 15 rental months have been paid, title to the equipment remains with the medical equipment supplier; however, the supplier may not charge you any additional rental amounts.


In making your decision to rent or purchase the equipment, you should know that for purchased equipment your supplier may charge you each time your equipment is actually serviced. You are responsible for the 20 percent coinsurance amounts and, for unassigned claims, the balance between the Medicare allowed amount and the supplier's charge. However, for equipment that is rented for 15 months, your responsibility for such service is limited to 20 percent coinsurance on a maintenance and servicing fee payable twice per year whether or not the equipment is actually serviced.

Wheelchairs (customized)

Please follow the billing guidelines below when you bill Blue Cross for customized wheelchairs:

File the entire customized wheelchair claim using HCPCS code E1220, and we will reimburse the entire claim at Manufacturer's Suggested Retail Price (MSRP) minus 25 percent discount of charges. These claims require detailed invoices to be submitted. To expedite this process, please submit hardcopy paper claims and supporting documents.

• Evaluation and set-up fees will not be reimbursed separately.

• Use K0739 to bill for equipment maintenance that is not covered under the warranty.

Reimbursement will be based on the allowable charge.



Wheelchairs (non-customized)

Wheelchair accessories must be billed on the same claim form as the wheelchair itself. Multiple accessories using code K0108 should each be billed on a separate line.

For purchased DME/HME, the participating DME/HME supplier must provide a one-year warranty agreement to the member. This warranty agreement may include some nominal monetary fee that is billable to the member. The participating DME/HME supplier must always inform the member about any DME/HME warranty provided by the manufacturer.

The DME/HME supplier agrees to provide all DME/HME services and supplies and orthotic and prosthetic devices, if applicable, according to the following standards:

• Free delivery;

• Free installation;

• Seven day-a-week, 24-hour emergency services by both technicians and professionals;

• Rental equipment repair and maintenance service (same day service, if required);

• Clinical professionals for patient education and home management, and, where necessary, written graphically-illustrated patient education and instruction manuals; and

• Availability of standard/economical models that meet the patient’s needs and quality standards.