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Thread: HCPCS codes for Tilite chair? What's reasonable?

  1. #1

    HCPCS codes for Tilite chair? What's reasonable?

    I got amazing news on Xmas, my chair was approved by BCBS!
    Today I got the breakdown of what was submitted/approved. DME put 2,500 of "upgrades" on prescription form for my Dr. to sign (convenient round number for ZRA upgrade, scissor locks, fenders, caster/wheels, Surge lt, vfront, open loop footrest, push handles, carbon back release bar). These weren't submitted individually, I was told I would need to pay the 2,500 quoted in upgrades because these pieces individually, if approved, insurance only reimburses _$ and I would be responsible for any additional amount. Insurance said that's ridiculous, entire chair/pieces should be submitted, that I have a very good plan and that was the point of the plan. I did my best to provide my DME with HCPCS codes other than K1080, the code he said didn't reimburse him enough. Is there a place Tilite lists these codes? I had to guess I had the right code on a few.
    Am I being unreasonable asking for every piece to be submitted? What do DME's usually do when submitting? I have a PPO and just reached my out of pocket maximum. BCBS said everything approved would be covered 100%.
    I purchased my last chair on my own, didn't go through DME so I'm not sure what's normal or not. Thank you for the help if you made it this far!

  2. #2
    Senior Member Oddity's Avatar
    Join Date
    Oct 2008
    Virginia Beach, VA
    Blog Entries
    It's K0005.

    Ask insurance for another in-network DME. This one is obviously giving you the run around. It's been a ridiculous amount of time, too. Shouldn't be this much of a hassle. Never has been for me and I've gone through it 4 times in the past 11 years.

    If your insurance company says it covers DME at 100%, after your deductible, then DME is screwing you. He should know all the right codes, that's his job. And, YES, every last thing gets submitted. EVERyThInG.
    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  3. #3
    Senior Member CapnGimp's Avatar
    Join Date
    Jun 2004
    Newport,TN USA male T4complete
    Blog Entries
    Agree 100% with Oddity. JUST got through getting a new one myself and the DME would have robbed me blind if I would have let him.

  4. #4
    Just an fyi, many insurances are going to require you submit the order again for approval if you make changes once approved. You might want to get that rigidizer bar taken care of before this gets approved.

  5. #5
    Senior Member
    Join Date
    Apr 2012
    Orlando, FL
    This is a disgusting thought that I know is a reality. DME's think: wheelchair = crippled, stupid, timid; therefore pushover.

    IG, price your chair on TiLite's order form. This will tell you all the upcharges.
    Rollin' since '89. Complete C8

  6. #6
    This will help follow the link I provided. Look up your chair click, you will be directed to the order form. It will list hcpcs codes for every upgraded option. Good luck

  7. #7
    I had similar problems with my dme who are you useing ? Bcbs told me all my options are covered was 3500 in upgrades but my dme told me I need to pay that upfront because sometimes the Insurance will say that then deny them but I think that's bs having me come up with that kinda money for items they got approved and they refuse to order unless I pay I'm just wondering if your housing new motion they have been very sketchy and after reading reviews I'm not the only one they try crap on. Even tho after contacting the CEO they are fixing other problems so I can't complain about them to much well until I get my second new chair all paid for

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