Hey, this is Kevin with All Star Medical. And today, we’re going to go over one of the biggest questions that we’ve gotten when it comes to products. It’s does Medicare cover lift chairs. First thing I want to touch base on is what is a lift chair? A lot of people have a misconception that lift chairs are actually the devices right here, lift obviously chair.
These are called a stair lift. Medicare does not cover these. But I like to show the difference. So this is a stair lift. And what you’ll see behind us are lift chairs. Every one of these chairs right here are lift chairs.
And what I want to go over is what insurance covers if you meet the qualifications, that I’ll get to in a minute, are the seat lift mechanism. So they actually don’t pay for the chair. They only pay for the lift mechanism underneath the chair. These chairs have one and two motors. So they technically have one in two seat lift mechanisms.
I’m going to fold this, I’ll raise this up and show this to you. This is the mechanism under here, this whole contraption. And what this does is it works on the same scissor mechanism. And it folds the chair back and forth and raises it up and down. That’s what they pay for. They do not pay for the actual chair itself. So a lot of people assume Medicare pays for it and it’s covered.
Well, it’s not. So that’s a one-motor chair. Two-motor chairs, I’ll show you a quick system here. Raise this up and you’ll see that there are two motors inside of here. The insurance companies are only going to pay for one lift mechanism.
They are going to be able to raise you up, out of a seated position, you know, to virtually a standing position. A lot of these chairs will actually recline, the two-motor chairs, to an infinite position, to get you into
trendelenburg mode, get you into zero gravity positioning, all that sorts of stuff. So all of them, every one of these chairs you’ll see here actually lifts. But I just wanted to really touch base on the lift part of it. Over here, I’ve got our computer and some documentation to show you where I get the information from, because I always like doing this.
I don’t want people to think that, you know, we’re making this up. We bring it, you know, right from the horse’s mouth. I’ve got one of the manufacturers, Pride Mobility which is one of the biggest manufacturers of lift chairs out there. and they basically go over, “Medicare will not cover a lift chair if you’re in a hospital or in a skilled nursing facility.” So they don’t cover that if you’re in the hospital or skilled nursing facility.
That is a requirement that either it’s paid out of pocket or the facility would have to show why it was needed within the hospital or a nursing facility for you to get one. The insurance is not going to pay for that. You will need to qualify for the lift chair if Medicare has paid…you will not qualify for the lift chair if Medicare has paid for a manual wheelchair, scooter, or power wheelchair.
You may still qualify if the doctor determines your condition has improved and you are now able to walk even if it’s with a cane or walker. But I like to tell people that if you’ve had a walker, I’m sorry, a wheelchair, a scooter, or a power wheelchair, you have what they call, you’re non-mobile in Medicare and the insurance’s eyes.
They can see your not active because you’re wheelchair-bound and you can’t stand up. Well, one of the questions to qualify for a seat lift mechanism is once standing, does the patient have the ability to ambulate? If you can do that, that’s great. But if insurance has paid for that wheelchair, power wheelchair, or scooter, they considered you non-ambulatory or you wouldn’t need this item.
So they’re going to red flag that, and the claim, in most all cases, are going to get denied. But this is basically the checklist to show if you qualify for it under Medicare guidelines. Does the patient have severe arthritis of the hip or knee? Does the patient have a severe neuromuscular disease?
You have to have one question, one or two, one of them have to be yes. If neither one of those are yes, you do not qualify for the seat lift mechanism. So I always like to let people know that. And then once standing, is the patient able to ambulate? Third question here is, is the patient completely incapable of standing up from a regular armchair or any chair in his or her home?
So those are the qualifying factors. This is the form that actually gets sent over to the doctor. And you had to have documentation along with this form to justify the qualification of the seat lift mechanism. Again, I keep beating on the seat lift mechanism because reimbursement on average is around $250 for the seat lift mechanism.
So if the chair is $1,000, if your Medicare and your supplemental pick up the $250, you’re still out-of-pocket that difference. Not many people realize that. They think, “My supplemental will pay for the chair.” They do not. They pay for the rest of the seat lift mechanism.
Medicare pays 80% on their claims for medical or durable medical equipment products, and then the supplemental will pick up the 20% of the covered item. On the computer here, I’ve actually went to cgsmedicare.com. And this is the jurisdiction. So I can actually go on here and select the state.
I’m going to do the fourth quarter in 2018, because that’s the most recent. And then the code for billing is E0627, okay? That is the billing code for a lift chair. When you search this database, the reimbursement is $253.13.
Medicare will pay 80% of that and the supplemental will pay the rest. So it’s about $200 for Medicare and around $50 for the supplemental. So this is all on the website, cgsmedicare.com. You can go on there and look at all this information.
I have you the certificate of medical necessity, that’s right here. I also have the local coverage and determination. If you watched narrative videos, we did one on a hospital bed. Again, a seat lift mechanism is covered if all of the following criteria are met. So as you can see, there’s the four questions.
All of that criteria has to be met. And again, this is on cms.gov, Medicare coverage database. So all this is online. It’s free for you guys to go look at it, read up on it. But I always want to emphasize, you know, the criteria. A lot of people say, “Oh, my doctor wrote an order for it.”
Man, that’s just a starting point. With prescriptions, you can, a lot of times, get to save the sales tax in your state. So, you know, saves you a little bit of money having a prescription because it’s a medical device. It will save you money there. But just because your doctor wrote it does not mean you qualify for it. The insurance companies are the ones who run whether you qualify for it, not your doctor.
So if your doctor then have the documentation or you don’t have the diagnosis that you need to meet the guidelines for the equipment, they’re not covered. Again, I hope this helps explain a lot of the things that we get questions about. Again, we’re going to kind of view some of the chairs that we have. We have around 70 lift chairs total between our Hermitage and our Franklin store.
The prices range from $499, all the way up to about $2,500. So it’s really about finding what chair works best for you. You know, you need a chair that has the right height, the right size. Most of your chairs have a 375-pound weight capacity.
There are chairs that have 500, 700-pound weight capacity. So there are options out there. But the big thing is just knowing what your insurance is going to cover, what they’re not. And that’s what we try to do here at All Star Medical. You can go online because I’m going to post this on our blog at allstarmedicalllc.com. We have this on the YouTube video as well as on Facebook. So follow us.
We’re all the time putting interesting information out, trying to be as informative as possible. I hope this was beneficial for you. We have a location in Hermitage, Tennessee, and in Franklin, Tennessee. We ship all over the country. So we can ship anywhere in the continental United States. And our phone number is 615-730-9438. Thanks.
And have a great day.