Reimbursement Issues

Insurance reimbursement is highly dependent upon establishing medical necessity, the individual provider’s policies and the individual patient’s coverage. Following are types of Reimbursement providers:

• Medicare Insurance – maximum allowable limits may vary state-by-state. General requirements include Medicare A or B participation, yearly deductible limits, and satisfaction of medical necessity guidelines. Note: the HCPCS code for "patient lift, electric, with seat or sling," is EO635.
• State Medicaid Insurance – requires a prescription in order to initiate a Prior Authorization Request.
• Private Insurance – these individual providers should be contacted directly to determine "maximum allowable" amounts
• Workers' Compensation Insurance – review the individual provider to determine their preferred providers.
• Veterans Administration – the VA Prosthetics Division is usually the organization responsible for purchase of patient lifts. The case manager or patient can contact the prosthetics department
• Vocational Rehabilitation Departments – these are often overlooked sources of funding and should be investigated if the patient might possibly rejoin the workforce
• Local/Regional Funding Resources – Church groups and public service organizations (Elks, Masons, Rotary, etc.) may have funds available to offset any cost overages.

This information is for general guidance only. Consult with payers to determine the exact extent of coverage for lifts and accessories.