A  In most cases a Doctor's written prescription (Rx) is all that is required, or Dispensing Order written by the treating physician must be sent to us before an item can be shipped.  Some items require a Detailed Written Order (DWO) prior to delivery or a Certificate of Medical Necessity (CMN).  You can view or Download Medicare Forms here.

• A description of the item
• The beneficiary's full name
• The date of order; and
• Physician's signature and date

Q    What do we need to begin processing your Medicare claim?

A         You can fax or email us the following information:

• Full legal name of patient, address, phone number.
• Full name, FAX number and UPIN of prescribing doctor.  (Ask doctor for their UPIN number)
• Doctor's prescription for desired equipment, which must include patient's diagnosis.
• Patient's Medicare number, which must include the alpha character after the number (A, B, D, etc).
• Patient's date of birth.
• Patient's height & weight.

You can FAX this information to us at 214-265-7817, or mail it to us at:

Preferred Healthcare
attn: Medicare Processing
10362 Miller Rd
Dallas, TX  75238

See our Medicare Claims page for step-by-step instructions and what we will need to file a Medicare Claim for you.

Q  What does  "assigned"  and  "non-assigned"  mean?

A   "Assigned" means the supplier accepts the Medicare-approved fee for the equipment.  Medicare pays for 80% of the approved fee.  The beneficiary is responsible for the remaining 20%. "Non-assigned" means the beneficiary pays the supplier in full for the equipment and the supplier submits the claim to Medicare.  If the item is covered, Medicare reimburses the beneficiary 80% of the approved fee.  We can help determine if you qualify for benefits.

Q   What is Covered by Medicare? 

A  Medicare Part B helps pay for durable medical equipment, including;

• manual wheelchairs (capped rental)
• power wheelchairs
• some positioning devices 
• walkers , rollators
• scooters 
• seat-lift mechanisms for lift-chairs 
• mattress over-lays (capped rental)
• hospital beds, semi-electric type only (capped rental)
• patient lifts   (capped rental)
• oxygen equipment  (capped rental)
• artificial limbs
• orthotics, splints  

Q  What is NOT covered by Medicare?

A  Equipment not covered by Medicare includes; adaptive daily living aids such as: ramps, automobile lifts, reachers, sock-aids, utensils, transfer benches, shower chairs,  raised toilet seats, and grab bars.  Basically, Medicare stops at the bathroom door. For more detailed information regarding coverage, call 1-800-MEDICARE.

Q  What is covered in a nursing home or skilled nursing facility? 

Q  What is considered, Home?

A  Home medical equipment must be appropriate for use in the home. Your "home" is your house, assisted living facility, apartment, a relative's home, or a group home in which you live. However, certain facility's are NOT CONSIDERED YOUR HOME:  a hospital, skilled nursing facility, or nursing facility. 

Q Are manual wheelchairs covered by Medicare?

A   In almost all cases, manual wheelchairs are covered by Medicare as a "Capped Rental."  This means that Medicare pays approx. 80% of the monthly rental and you are responsible for the remaining 20% or this may be covered by secondary insurance.  You must use a local dealer that rents chairs and bills Medicare for the monthly rental fees.  Some Ultra-lightweight wheelchairs have a K0005 Billing code and can be billed as a purchase.  However, PHC bills Internet purchases on a non-assignment basis only. 

All manual wheelchairs on our website are for purchase only. Medicare does not reimburse for the purchase of a wheelchair.

See all manual wheelchairs

Q  Are walkers and rollators covered?

A  Medicare will allow a walker or rollator every 5 years.  They cover 80% of the allowed amount set by Medicare.  If you have a supplement insurance that covers the 20%, reimbursement is usually about $125.00.  Regardless of whether your rollator cost $150 or $350, the reimbursement amount is basically the same, unless qualifying for heavy-duty or Bariatric walker. Rollators are coded as walkers with appropriate accessories (wheels, seat, hand brakes).

See all Walkers and Rollators

Q   Does Medicare pay or reimburse for Adjustable Beds?

A   Medicare coverage for a bed is limited to a hospital bed and all hospital beds are covered as a capped rental only.  Medicare does not cover Adjustable Beds. See next FAQ answer for coverage details.

See all Adjustable Beds

Q   Does Medicare pay or reimburse for Hospital Beds?

A   Medicare covers hospital beds as a Capped Rental item.  This means that you must use a vendor in your local area that rents equipment and bills Medicare for the monthly fees.  Your local dealer will install and maintain this "capped rental" equipment.  Medicare does not consider a full-electric hospital bed, Adjustable Bed, or other Luxury beds to be medically necessary.  Medicare coverage is for a Semi-electric twin-size hospital bed.

See all Hospital Beds

Q   Are Overbed or Bedside Tables covered by Medicare?

A  Over-Bed Tables an Bedside Tables are not classified as a medical necessity and are not covered. 

See all Bedside Bed Tables

Q   Are Oxygen Concentrators, CPAP and Nebulizers covered by Medicare?

A  Oxygen Concentrators, CPAP and other respiratory products such as Nebulizers are Capped Rentals thru Medicare. For these products you should seek a local dealer that rents equipment and bills Medicare.  All respiratory products are for purchase only .

See all Respiratory products.

Q   Are Transfer Boards covered by Medicare?

A  Transfer boards  may be considered medically necessary for patients with medical conditions that limit their ability to transfer from wheelchair to bed, chair, or toilet. We file Medicare claims for Transfer Boards on a non-assignment basis only.

See all Transfer Boards.

Q   Are Patient Lifts covered by Medicare?

A  Patient Lifts are reimbursed as a capped rental item.  This means that you must visit a local dealer/retailer that rents such equipment and bills Medicare for the monthly fees.  Medicare reimburses 80% of rental for up to 12-months. We do not bill Medicare for Patient Lifts sold over the Internet. This capped-rental coverage is for a standard hydraulic-manual lift and sling.  Power Lifts and Standing Lifts are not covered.

See all Patient Lifts

Q  What is Medicare's coverage criteria for motorized or power wheelchairs?

A  Medicare will pay for a motorized wheelchair. Although it is not guaranteed that you will qualify or be reimbursed by Medicare, whether you personally lay out the price for one, or are looking for Medicare to purchase one for you, we can give you some guidelines to follow and the basic criteria that must be met in order for Medicare to either reimburse or authorize payment for a motorized unit.  

A power wheelchair is covered when all of the following criteria are met: 

• The patient's condition is such that without the use of a wheelchair the patient
  would otherwise be bed or chair confined.
• The patient's condition is such that a wheelchair is medically necessary and the
  patient is unable to operate a wheelchair manually.
• The patient is capable of safely operating the controls for the power wheelchair.

A patient who requires a power wheelchair usually is totally non-ambulatory and has severe weakness of the upper extremities due to a neurological or muscular disease/condition.  If the documentation does not support the medical necessity of a power wheelchair but does support the medical necessity of a manual wheelchair, payment is based on the allowance for the least costly medically appropriate alternative. However, if the power wheelchair has been purchased, and the manual wheelchair on which payment is based is in the capped rental category, the power wheelchair will be denied as not medically necessary. Options that are beneficial primarily in allowing the patient to perform leisure or recreational activities are non-covered. Read more about requirements for Power Mobility Devices (PMDs) in this Note to Physicians on Scooters & Power  Chairs.

See all Power Wheelchairs.

Q  What is Medicare's coverage of power operated Vehicles (POVs) or scooters?

A  A power operated vehicle (POV) is covered when all of the following criteria are met:

• The patient's condition is such that a wheelchair is required for the patient to get
  around in the home.
• The patient is unable to operate a manual wheelchair.
• The patient is capable of safely operating the controls for the POV.
• The patient can transfer safely in and out of the POV and has adequate trunk stability to be able to safely ride in the POV. 

Most POVs are ordered for patients who are capable of ambulation within the home but require a power vehicle for movement outside the home. POVs will be denied as not medically necessary in these circumstances. A POV that is beneficial primarily in allowing the patient to perform leisure or recreational activities will be denied as not medically necessary. If a Mobility Scooter is covered, a wheelchair provided at the same time or subsequently will usually be denied as not medically necessary. Read more about requirements for Power Mobility Devices (PMDs) in this Note to Physicians on Scooters & Power  Chairs.

See all Power Scooters

Q  Will Medicare pay for a Lift Chair?

A  Only the seat lift mechanism on a lift chair could be considered medically necessary if all of the following coverage criteria are met:

• The patient must have severe arthritis of the hip or knee or have a severe neuromuscular disease.
• The seat lift mechanism must be a part of the physician's course of treatment and be prescribed to effect improvement, or arrest or retard deterioration in the patient's condition.
• The patient must be completely incapable of standing up from a regular armchair or any chair in their home. (The fact that a patient has difficulty or is even incapable of getting up from a chair, particularly a low chair, is not sufficient justification for a seat lift mechanism. Almost all patients who are capable of ambulating can get out of an ordinary chair if the seat height is appropriate and the chair has arms.)
• Once standing, the patient must have the ability to ambulate (walk). 

Coverage of seat lift mechanisms is limited to those types which operate smoothly, can be controlled by the patient, and effectively assist a patient in standing up and sitting down without other assistance. Coverage is limited to the seat lift mechanism, even if it is incorporated into a chair. Medicare reimbursement is approximately $275.00. See Medicare reimbursement criteria for Lift Chair

See all Lift Chairs

Q  Does Medicare cover the cost of Diabetic Shoes?

A  Medicare does reimburse for, or authorize the coverage of Diabetic shoes, if the shoes are fitted to your feet by a Pedorthist.  Most cases involve "heat molding" the shoe or insert to your feet such that the foot condition is treated properly.  Even with this personal fitting, the shoes must be prescribed by a qualified physician treating a foot condition resulting from Diabetes.  In addition, the person fitting and providing the shoes must be approved by Medicare and must be a Medicare provider in order to properly bill for the product.  Medicare will cover 1 pair of shoes and 3 pairs of inserts per calendar year. Patients seeking Medicare coverage of shoes are usually diagnosed with peripheral neuropathy.

See all Diabetic Shoes and Footwear

Q  Does Medicare cover Wheelchair Lifts and Ramps?

A  Medicare does not reimburse nor authorize the purchase of mobility lifts or ramps for a wheelchair or scooter at this time. Such items are typically not considered a medical necessity because they can also be used by persons without a medical condition.

See all Wheelchair and Scooter Ramps

Q  Do I have to pay the 20% co-payment to Medicare?

A  After you have met your deductible, you're still responsible for paying directly, or through supplemental insurance, at least 20 percent of the Medicare approved amount. This co-payment may not be dropped by the supplier except in hardship situations and only on a case-by-case basis. A supplier who routinely drops the co-payment may be violating federal law. 

If you qualify for Medicare billing use these step-by-step directions for How to File Medicare Claim.

Got a question for us?   Click here and email it to service@phc-online.com