Page 3 of 3 FirstFirst 123
Results 21 to 26 of 26

Thread: Finally gonna try to use Medicare to get a chair

  1. #21
    Senior Member NW-Will's Avatar
    Join Date
    Apr 2008
    Location
    Vancouver WA USA - - Male T4 ASIA B incomplete
    Posts
    1,650
    I should know this by now.
    What is the most $$ Medicare(80%) will pay for the basic ultralight chair (K0005) without any of the extra add on HCPCS
    (Healthcare Common Procedure Coding System) K codes ?
    Is there a source somewhere online for the amount the DME gets for the K codes?
    It's about $2000.00 I believe.

    Be interesting to see a comparison of which K codes each DME uses when getting reimbursement for folks chairs too.

    K0020 - Fixed, adjustable height armrest, pair
    K0040 - Adjustable angle footplate, each

    etc..

    https://hcpcs.codes/k-codes/


  2. #22
    Senior Member Oddity's Avatar
    Join Date
    Oct 2008
    Location
    Virginia Beach, VA
    Posts
    3,161
    Blog Entries
    1
    The allowable for K0005 is indeed ~$2000. It varies by state. In VA it's ~$2050 this year. CMS has the DME Fee Schedule available for download on their main site.

    https://www.cms.gov/Medicare/Medicar...-Schedule.html

    Medicare always send a EoB explaining what they were billed for and what they paid.

    The further down this rabbit hole I get the more I'm suspecting DME retailers shenanigans when it comes to titanium chairs. They're all coded the same, and TiLite's chairs all have current classification under K0005. I don't think Medicare cares since they're paying out the $2,050 no matter what chair you medically qualify for under K0005. You know who does care? Manufacturers and DMEs. I don't think it's an accident that getting a ZR is now an upgrade to the base ZRA. Medicare DOES care about upgrades.



    Quote Originally Posted by NW-Will View Post
    I should know this by now.
    What is the most $$ Medicare(80%) will pay for the basic ultralight chair (K0005) without any of the extra add on HCPCS
    (Healthcare Common Procedure Coding System) K codes ?
    Is there a source somewhere online for the amount the DME gets for the K codes?
    It's about $2000.00 I believe.

    Be interesting to see a comparison of which K codes each DME uses when getting reimbursement for folks chairs too.

    K0020 - Fixed, adjustable height armrest, pair
    K0040 - Adjustable angle footplate, each

    etc..

    https://hcpcs.codes/k-codes/

    "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. #23
    I use to have an Tilite Aero X and the Tilite Aero Z looks pretty good. Both these chair should be covered. I normally just pay cash for my chairs, no way would medicare cover the carbon fiber chair I currently use as it was 4500 bucks.
    "Life is about how you
    respond to not only the
    challenges you're dealt but
    the challenges you seek...If
    you have no goals, no
    mountains to climb, your
    soul dies".~Liz Fordred

  4. #24
    I just used Medicare to get a wheelchair. I am on Aetna Medicare Advantage, but it doesn't really matter if you have straight Medicare or an Advantage plan. Either way they are going to pay 80% of the approved cost. I worked with NuMotion (not my first choice) but they are in network. I had to first go the the Dr. to get a prescription, then a physical therapist, with the therapist NuMotion speced out the chair and now it is back to the Dr. for a signature. It is a Tilite Areo Z. NuMotion informed me that Medicare will not approve a titanium chair. This is also including a Smart Drive. I don't know what my out of pocket will be yet, but the first estimate is $1400.

    Mark

  5. #25
    Quote Originally Posted by Curt Leatherbee View Post
    I use to have an Tilite Aero X and the Tilite Aero Z looks pretty good. Both these chair should be covered. I normally just pay cash for my chairs, no way would medicare cover the carbon fiber chair I currently use as it was 4500 bucks.
    Hey Curt,

    You have a 4.5K carbon fiber chair? Can you send a link to the companies website?

  6. #26
    Senior Member Oddity's Avatar
    Join Date
    Oct 2008
    Location
    Virginia Beach, VA
    Posts
    3,161
    Blog Entries
    1
    Motioncomposites.com
    "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

Similar Threads

  1. Replies: 18
    Last Post: 09-04-2008, 09:37 PM
  2. finally got my new chair
    By jessie.gray in forum Equipment
    Replies: 2
    Last Post: 07-04-2007, 03:03 PM
  3. Finally ordered chair
    By jbinny in forum Equipment
    Replies: 10
    Last Post: 06-12-2007, 11:36 PM
  4. Finally Ordered My Chair
    By SteveW in forum Equipment
    Replies: 2
    Last Post: 04-14-2006, 05:28 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •