Funding - Seat Lift Chairs

SEAT LIFT CHAIRS

Medicare Coverage Criteria

A seat lift mechanism is covered if all of the following 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.

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. Excluded from coverage is the type of lift which operates by spring release mechanism with a sudden, catapult-like motion and jolts the patient from a seated to a standing position. Coverage is limited to the seat lift mechanism, even if it is incorporated into a chair.

If you feel you meet these requirements, you may be eligible to receive the most stylish, best performing and most reliable lift chair available on the market today.

Beneficiary Information
Seat Lift Chair

Dear Medicare Beneficiary,

You may be eligible to receive a portion of your money back from Medicare when you purchase a Seat Lift Chair. To qualify you must have Medicare Part B coverage and meet certain medical coverage criteria as determined by your physician.

Here are some common questions regarding Medicare Reimbursement.

Will Medicare pay for a Seat Lift-Chair?

If you qualify, Medicare will pay for a portion of your Seat Lift-Chair. The portion that Medicare will pay for is the seat lift mechanism that is incorporated into a Seat Lift-Chair.

What is a seat lift mechanism?

The seat lift mechanism is the portion of the lift chair that gently lifts you to a standing position. It includes the metal frame on which the chair rests, the lift motor, the scissors mechanisms and the hand control unit.

If I qualify, how much will Medicare pay towards the purchase of a Seat Lift-Chair?

Medicare will pay 80% of a set allowable for a seat lift mechanism. The amount depends on your state of residence. On average the amount reimbursed by Medicare is around $250.00.

How do I know if I qualify?

Medicare has certain medical criteria that need to be met before Medicare will pay for a seat lift mechanism. Medicare requires a Certificate of Medical Necessity, also known as a CMN, to be completed by your physician based on your medical condition. Generally, Medicare will only pay for the seat lift mechanism if the patient has a neuromuscular disease or severe arthritis of the hip or knee that completely prevents the patient from standing up from a regular armchair or any chair in their home. Medicare also requires that once standing the patient must have the ability to ambulate. Additionally, the seat lift mechanism must be part of the physician's course of treatment and be prescribed to effect improvement, or arrest or retard deterioration in the patient's condition.

How do I submit a claim to Medicare? What other information needs to be sent?

Once you have a completed CMN signed by your physician and after you purchase the Seat Lift-Chair, we will submit a claim along with the CMN to Medicare on your behalf. Medicare will process your claim and inform you of their payment decision in about 30-45 days.

Medicare Carrier by State

If you reside in:

CT, DE, ME, MA, NH, NJ, NY, PA, RI, VT
Your Medicare Carrier is:
United Healthcare
Region A DMERC
PO Box 6800
Wilkes-Barre, PA 18773
Phone: (800) 842-2052

If you reside in:

DC, IL, IN, MD, MI, MN, OH, VA, WV, WI
Your Medicare Carrier is:
AdminiStar Federal
Region B DMERC
PO Box 7031
Indianapolis, IN 46207
Phone: (800) 270-2313

If you reside in:

AL, AR, CO, FL, GA, KY, LA, MS, NM, NC, OK, SC, TN, TX
Your Medicare Carrier is:
Palmetto GBA
Region C DMERC
PO Box 100141
Columbia, SC 29202-3235
Phone: (800) 213-5452

If you reside in:

AZ, AK, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY
Your Medicare Carrier is:
CIGNA
DMERC Region D
PO Box 690
Nashville, TN 37202
Phone: (800) 899-7095