Funding - Power Scooters

CRITERIA FOR SCOOTERS (HCPCS Code E1230)

Our clients frequently ask if their Medicare insurance will cover the purchase of a Power Scooter that they wish to purchase from Advanced Medical Concepts. Although we cannot guarantee reimbursement by Medicare, we can give some guidelines to follow and the basic criteria that must be met in order to qualify for Medicare reimbursement.

To be considered medically necessary, the following coverage criteria must all be met:

The patient is unable to operate a manual wheelchair.
The patient is capable of safely operating the controls for the scooter.
The patient can transfer safely in and out of the scooter, andhave adequate trunk stability for safety.
The patient is capable of safely operating the controls for the scooter.
The patient can transfer safely in and out of the scooter, and have adequate trunk stability for safety.
The patient's condition must be such that a POV is required for the patient to get around in his or her residence. A POV that is beneficial primarily in allowing the patient to perform leisure or recreational activities will be denied as not medically necessary.

This means that Medicare will NOT consider coverage of your Scooter if…

You can walk.
You can use a manual wheelchair.
You only need the Scooter for leisure activities.
You would not need the Scooter for use in your home.

In order for us to file a claim with Medicare, a Certificate of Medical Necessity (CMN) must be completed (enclosed.) The ordering physician must answer all questions in Section B on the CMN and sign and date the form.

Medicare requests that the physician ordering a scooter be one of the following specialists: Rehabilitation medicine specialist, Orthopedic Surgeon, Neurologist or Rheumatologist.

Along with a CMN, a letter on the Doctors letterhead identifying his specialty (i.e. Rehabilitation Medicine specialist, Orthopedic Surgeon, Neurologist or Rheumatologist.) must contain the following information:

Date and patient name.
The fact that the scooter will be used indoors.
Patient diagnosis. Describe in detail, the patient’s physical condition.
Describe the functional limitations that support the need for a scooter.

Please forward the completed CMN and letter to our office. Upon receipt of these documents we will forward it to the pre-authorization department of Medicare.

Please understand that Medicare is a slow process, and the approval decision is entirely at the discretion of Medicare and the physician. Advanced Medical does not approve or deny the claims.

If you choose not to wait for the pre-authorization you may purchase the scooter privately. We will then submit the claim to Medicare and payment (if authorized) will be sent directly to you.

Please feel free to contact our reimbursement department if you should have any further questions. They can be reached at 410-902-7900 or 1-800-860-3185

We thank you for the opportunity to serve you and apologize for any inconveniences this lengthy process may cause you.