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Thread: wheelchairs/cushions on spinlife

  1. #1

    wheelchairs/cushions on spinlife

    i just learned this stuff which is somewhat contradictory. they say they'll bill medicare for chairs and such but apparently not.

    "this is clicking on the medicare billing box of a gpv".....

    Courtesy Medicare Billing

    >>>>FREE courtesy Medicare billing is available for this item!<<<<

    You may request Medicare Courtesy Billing during checkout online or by phone.

    Please note: SpinLife cannot provide courtesy billing for Medicaid.

    Please see our Medicare Policy (opens in a new window) for complete details.


    "this is clicking their medicare policy".....

    Can you bill Medicare for a manual wheelchair, hospital bed, or patient lift?

    Medicare only provides coverage for these items on a rental basis. The item will 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.

    Because SpinLife only sells new equipment and does not provide rentals, >>>>we cannot provide courtesy billing on these items.<<<< Many consumers choose to purchase the items they need outright from SpinLife because the purchase cost is often comparable to the 20% copay they would be required to pay to a local dealer for a rental. Purchasing from SpinLife also guarantees that you will receive new items instead of used, and that you get exactly what you want.

    * Please contact us for information about billing on K0005- Ultralightweight Wheelchairs.


    "this is the cushion part".....

    What is the reimbursement criteria for wheelchair cushions?

    For wheelchair cushions, the wheelchair for which the cushion will be used must already be on file with Medicare because SpinLife must submit the manufacturer, model and the date of purchase of the wheelchair on file when courtesy billing for the corresponding cushion. >>>>The beneficiary must also either have a current pressure sore or have a pressure sore on record as Medicare will not cover any preventative items.<<<< This information must be submitted to SpinLife with the prescription.

    what's up with this??????

  2. #2
    Senior Member jschism's Avatar
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    I saw you had brought up trying to buy online with medicare somewhere else, too.
    Your 20% co-pay goes by what medicare is willing to pay, not what the DME is quoting, so there is no benefit to trying to buy at an online store with medicare. With medicare, or any other insurance as far as that goes, the vendors barely make anthing, so the deal will not be any better wether it's an online store or your local guy. you only save buying online for self pay stuff.

  3. #3
    mmmm, i can see the reasoning in that. but what about where they're sayin medicare will only cover a cushion if you have or had a pressure sore on record?

  4. #4
    Senior Member ~Lin's Avatar
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    You have medicare AND medicaid, correct? If so (judging from other threads you started) then you should go to an experienced DME. Medicare will pay 80%, and medicaid will pay the last 20% so there is no need to be busting your ass trying to learn how to get things paid for. If you go to a good DME they can tell you what is likely to be covered and how to get things covered. I've only been on this board a short time and have heard horror stories, but I luckily went with a very good DME or at least the seating therapist with that DME was wonderful.

    As for cushions, medicaid covered a basic wheelchair cushion for me. They would not cover a top of the line cushion since I lack a diagnosis that puts me at risk for pressure sores like paralysis does. From what I've read its similar with medicare, where they will frequently only cover a basic cushion until you've had a pressure sore and then consider an adequate cushion as treatment and not prevention.
    Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

    I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

  5. #5
    Quote Originally Posted by ~Lin View Post
    You have medicare AND medicaid, correct? If so (judging from other threads you started) then you should go to an experienced DME. Medicare will pay 80%, and medicaid will pay the last 20% so there is no need to be busting your ass trying to learn how to get things paid for. If you go to a good DME they can tell you what is likely to be covered and how to get things covered. I've only been on this board a short time and have heard horror stories, but I luckily went with a very good DME or at least the seating therapist with that DME was wonderful.

    As for cushions, medicaid covered a basic wheelchair cushion for me. They would not cover a top of the line cushion since I lack a diagnosis that puts me at risk for pressure sores like paralysis does. From what I've read its similar with medicare, where they will frequently only cover a basic cushion until you've had a pressure sore and then consider an adequate cushion as treatment and not prevention.
    well lin, i'm one of the horror stories, lol. my DME is sorry. i've never had problems until this year. they say my insurance changed from medicaid primary to medicare primary. which means to get anything i really want i gotta pay oodles out of pocket, when i used to could get anything i wanted and paid nothing. last time i got a tilite zra and a tub bench now i can't even get the cheapest chair without paying out of pocket.

  6. #6
    Senior Member ~Lin's Avatar
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    Sounds like you need to find a better DME! I had a wonderful experience with United Seating and Mobility. I realize other locations may not have staff as good as the one I used though.
    Last edited by ~Lin; 01-29-2012 at 05:20 AM.
    Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

    I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

  7. #7
    Hi rollin64. Thanks for for pointing out some of the wording we used on our website to expalin our Medicare billing was somewhat confusing. We have have made some revisions and hopefully you will find it to be easier to understand. If you need any assistance, please feel free to contact me at SpinLife. I've been in a wheelchair myself for over 25 years and always enjoy helping a follow user.

  8. #8
    Quote Originally Posted by SpinLifeJeff View Post
    Hi rollin64. Thanks for for pointing out some of the wording we used on our website to expalin our Medicare billing was somewhat confusing. We have have made some revisions and hopefully you will find it to be easier to understand. If you need any assistance, please feel free to contact me at SpinLife. I've been in a wheelchair myself for over 25 years and always enjoy helping a follow user.
    thanks, jeff. it's time for my new cushion and back. but i'm dealing with a sore right now that threw me for a loop, lol.

  9. #9
    Quote Originally Posted by rollin64 View Post
    thanks, jeff. it's time for my new cushion and back. but i'm dealing with a sore right now that threw me for a loop, lol.
    You might want to consider a wheelchair seating eval from a university or rehab ctr affiliated seating clinic. They would likely pressure map you and do a very professional recommendation which might net you better reimbursement in addition to helping w your sore issue.

  10. #10
    Senior Member
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    Quote Originally Posted by rollin64 View Post
    mmmm, i can see the reasoning in that. but what about where they're sayin medicare will only cover a cushion if you have or had a pressure sore on record?
    Here is Medicare's coverage criteria to provide reimbursement for the purchase of a skin protection cushion:
    A skin protection seat cushion (E2603, E2604, E2622, E2623) is covered for a patient who meets both of the following criteria:
    1. The patient has a manual wheelchair or a power wheelchair with a sling/solid seat/back and the patient meets Medicare coverage criteria for it; and
    2. The patient has either of the following:
    a. Current pressure ulcer (ICD-9-CM codes 707.03, 707.04, 707.05) or past history of a pressure ulcer
    (707.03, 707.04, 707.05) on the area of contact with the seating surface; or
    b. Absent or impaired sensation in the area of contact with the seating surface or inability to carry out a functional weight shift due to one of the following diagnoses: spinal cord injury resulting in quadriplegia or paraplegia (344.00-344.1), other spinal cord disease (336.0-336.3), multiple sclerosis (340), other demyelinating disease (341.0-341.9), cerebral palsy (343.0-343.9), anterior horn cell diseases including
    amyotrophic lateral sclerosis (335.0-335.21, 335.23-335.9), post polio paralysis (138), traumatic brain injury resulting in quadriplegia (344.09), spina bifida (741.00-741.93), childhood cerebral degeneration (330.0-330.9), Alzheimer's disease (331.0), Parkinson's disease (332.0),muscular dystrophy (359.0, 359.1), hemiplegia (342.00 – 342.92, 438.20-438.22), Huntignton’s chorea (333.4), idiopathic torsion dystonia (333.6), athetoid cerebral palsy (333.71).

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