Medicare Reimbursement for Power Operated Vehicles
For more information contact Jerri Lynn Ward.
Posted October 31, 2002
Are Power Operated Vehicles Covered Under Medicare?
Yes, but make sure a specialist orders the POV and thorough documentation exists to prove it is medically necessary.
Under what Conditions Does Medicare Reimburse for the Cost of a Power Operated Vehicle?
If medically necessary, Power Operated Vehicles (POVs), such as “Scooters,” are covered under Medicare Part B as a durable medical equipment expense. POVs qualify for Medicare reimbursement only if the POV is prescribed for the patient by a physician before the scooter is purchased.
What Forms Have to Be Completed?
A certificate of medical necessity must also be completed by the physician prescribing the use of a Power Operated Vehicle. A Certificate of Medical Necessity (CMN) is a form required by Medicare authorizing the use of certain durable medical items and equipment prescribed by a physician.
Can My General Physician Prescribe a Power Operated Vehicle?
Medicare requires that the POV be ordered by a physician who is one of the following specialties: Physical Medicine, Orthopedic Surgery, Neurology, or Rheumatology. When such a specialist is not reasonably accessible, e.g. more than one day’s round trip from the beneficiary’ s home, or the patient’ s condition precludes such travel, a prescription from the beneficiary’ s physician may be acceptable. However, this may cause a relay in Medicare payment, and thorough documentation is a must.
What Other Conditions Must Be Met to Qualify a POV For Medicare Coverage?
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, and
- 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
Under What Conditions Will Medicare Deny Payment for a POV?
- If the scooter or other POV was purchased before the physician prescribed it and/or filled out the certificated of medical necessity, the POV will not be covered by Medicare.
- If the patient is capable of ambulation within the home, but uses a power vehicle for movement outside the home, the POV will be denied as not medically necessary in these circumstances.
- If the POV is used for the primary purpose of performing leisure or recreational activities, Medicare will deny payment on the basis that the POV is not medically necessary.
Will Medicare Pay for both a Wheelchair and a POV?
No. If a POV is covered, a wheelchair provided at the same time or subsequently will usually be denied as not medically necessary.
What will it cost me?
Under Medicare Part B, the 2002 deductible is $100 and coinsurance is 20 percent. This means that after you pay the yearly $100 deductible, Medicare will pay 80 percent of the approved charges for covered services. You pay the other 20 percent, which is the coinsurance amount. Supplementary or co-insurance (Medicaid, Blue Cross, AARP, etc.) will pick up the other 20% in many cases.
If you have any questions as to whether Medicare will pay for a POV for you or your family member, do not hesitate to contact us.
All information in this article is informational only and is not legal advice. Should you have any questions or a situation requiring advice, please contact an attorney.
Copyright 2004 by Garlo Ward, P.C., all rights reserved
Austin, Texas 78752-3714 USA
Telephone: 512-302-1103
Facsimilie: 512-302-3256
Email: Info@Garloward.com
