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Thursday, July 20, 2017

Non-Covered Durable Medical Equipments by Medicare



In order for an item to be covered by the Durable Medical Equipment Medicare Administrative Contractor (DME MAC), it must fall within one of ten benefit categories. Medicare Part B covered services processed by the DME MAC fall into the following benefit categories specified in Section 1861(s) of the Social Security Act:

  1. Durable medical equipment (DME)
  2. Prosthetic devices
  3. Leg, arm, back and neck braces (orthoses) and artificial leg, arm and eyes, including replacement (prostheses)
  4. Home dialysis supplies and equipment
  5. Surgical dressings
  6. Immunosuppressive drugs
  7. Erythropoietin (EPO) for home dialysis patients
  8. Therapeutic shoes for diabetics
  9. Oral anticancer drugs
  10. Oral antiemetic drugs (replacement for intravenous antiemetics)

Some items may not meet the definition of a Medicare benefit or may be statutorily excluded. The items listed below will always be denied as non-covered. The Medicare National Coverage Determinations (NCD) Manual provides a list of items that are noncovered with the reason for denial. The following items will be denied as noncovered when submitted to the DME MAC. 


HCPCS DESCRIPTION
A4210
Needle-free injection device, each
A4250
Urine test or reagent strips or tablets (100 tablets or strips)
A4490
Surgical stockings above knee length, each
A4495
Surgical stockings thigh length, each
A4500
Surgical stockings below knee length, each
A4510
Surgical stockings full-length, each
A4520
Incontinence garment, any type, (e.g. brief, diaper), each
A4554
Disposable underpads, all sizes
A4575
Topical hyperbaric oxygen chamber, disposable
A4627
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler
A6000
Non contact wound-warming wound cover for use with the non contact wound-warming device and warming card
A6530
Gradient compression stocking, below knee, 18-30 mmHg, each
A6533
Gradient compression stocking, thigh length, 18-30 mmHg, each
A6534
Gradient compression stocking, thigh length, 30-40 mmHg, each
A6535
Gradient compression stocking, thigh length, 40-50 mmHg, each
A6536
Gradient compression stocking, full length/chap style, 18-30 mmHg, each
A6537
Gradient compression stocking, full length/chap style, 30-40 mmHg, each
A6538
Gradient compression stocking, full length/chap style, 40-50 mmHg, each
A6540
Gradient compression stocking, waist length, 30-40 mmHg, each
A6541
Gradient compression stocking, waist length, 40-50 mmHg, each
A6542
Gradient compression stocking, custom made
A6543
Gradient compression stocking, lymphedema
A6544
Gradient compression stocking, garter belt
A6549
Gradient compression stocking, not otherwise specified
A9270
Noncovered item or service
A9275
Home glucose disposable monitor, includes test strips
A9276
Sensor; invasive (e.g. subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, one unit = 1 day supply
A9277
Transmitter; external, for use with interstitial continuous glucose monitoring system
A9278
Receiver (monitor); external, for use with interstitial continuous glucose monitoring system
A9280
Alert or alarm device, not otherwise classified
A9281
Reaching/grabbing device, any type, any length, each
A9282
Wig, any type, each
A9300
Exercise equipment
B4100
Food thickener, administered orally, per ounce
E0172
Seat lift mechanism placed over or on top of toilet, and type
E0191
Heel or elbow protector, each
E0203
Therapeutic lightbox, minimum 10,000 lux, table top model
E0220
Hot water bottle
E0230
Cap or collar
E0231
Non-contact wound warming device (temperature control unit, AC adapter and power cord) for use with warming card and wound cover
E0232
Warming card for use with the non-contact wound warming device and non-contact wound warming wound cover
E0240
Bath/shower chair, with or without wheels, any size
E0241
Bath tub wall rail, each
E0242
Bath tub rail, floor base
E0243
Toilet rail, each
E0244
Raised toilet seat
E0245
Tub stool or bench
E0246
Transfer tub rail attachment
E0247
Transfer bench for tub or toilet with or without commode opening
E0248
Transfer bench, heavy duty, for tub or toilet with or without commode opening
E0270
Hospital bed, institutional type includes: oscillating, circulating and stryker frame with mattress
E0273
Bed board
E0274
Over-bed table
E0315
Bed accessory: board, table, or support device, any type
E0481
Intrapulmonary percussive ventilation system and related accessories
E0625
Patient lift, bathroom or toilet, not otherwise classified
E0637
Combination sit to stand system, any size including pediatric, with seatlift feature, with or without wheels
E0638
Standing frame system, one position (e.g. upright, supine or prone stander), any size including pediatric, with or without wheels
E0641
Standing frame system, multi-position (e.g. three-way stander), any size including pediatric, with or without wheels
E0642
Standing frame system, mobile (dynamic stander), any size including pediatric
E0700
Safety equipment (e.g., belt, harness or vest)
E0710
Restraints, any type (body, chest, wrist or ankle)
E0936
Continuous passive motion exercise device for use other than knee
E1300
Whirlpool, portable (overtub type)
J1055
Injection, medroxyprogesterone acetate for contraceptive use, 150 mg
J3520
Edetate disodium, per 150 mg
J3535
Drug administered through a metered dose inhaler
J3570
Laetrile, amygdalin, vitamin B-17
J8499
Prescription drug, oral, nonchemotherapeutic, NOS
J8515
Cabergoline, oral, 0.25 mg
L0210
Thoracic rib belt
L1800
Knee orthosis, elastic with stays, prefabricated
L1815
Knee orthosis, elastic or other elastic type material, with condylar pads, prefabricated
L1825
Knee orthosis, elastic knee cap, prefabricated
L1901
Ankle orthosis, elastic, prefabricated
L3651
Shoulder orthosis, single shoulder, elastic, prefabricated
L3652
Shoulder orthosis, double shoulder, elastic, prefabricated
L3700
Elbow orthosis elastic with stays, prefabricated
L3701
Elbow orthosis, elastic, prefabricated
L3909
Wrist orthosis, elastic, prefabricated
L3911
Wrist hand finger orthosis, elastic, prefabricated
L3215
Orthopedic footwear, ladies shoes, oxford, each
L3216
Orthopedic footwear, ladies shoes, depth inlay, each
L3217
Orthopedic footwear, ladies shoes, hightop, depth inlay, each
L3219
Orthopedic footwear, mens shoes, oxford, each
L3221
Orthopedic footwear, mens shoes, depth inlay, each
L3222
Orthopedic footwear, mens shoes, hightop, depth inlay, each
L7600
Prosthetic donning sleeve, any material, each
Q0144
Azithromycin dehydrate, oral, capsules/powder, 1 gram
V2025
Deluxe frame
V2600
Hand held low vision aids and other nonspectacle mounted aids
V2610
Single lens spectacle mounted low vision aids
V2615
Telescopic and other compound lens system, including distance vision telescopic, near vision telescopes and compound microscopic lens system
V2702
Deluxe lens feature
V2760
Scratch resistant coating, per lens
V5336
Repair/modification of augmentative communicative system or device (excludes adaptive hearing aid)

Information on Lift Chairs or Medical Lift Recliners


What is a Lift Chair?

Lift chairs are chairs that feature a powered lifting mechanism that pushes the entire chair up from its base and so assists the user to a standing position. Lift Chair is a piece of medical equipment that looks similar to a standard reclining chair. It can be used in an upright position, or reclined with just the push of a button. The difference is that the Lift Chair contains a powerful lifting system which can be triggered to tilt the base and back of the chair forward, assisting the user in returning to a standing position. The user operates a Lift Chair by pushing buttons on a remote rather than manually engaging a lever or switch.

There are a number of different names used to describe Lift Chairs. You may see them marketed as “Power Lift Recliners”, “Pop-Up Chairs, “3-Position Recliners”, or “Infinite Position Recliners”, but each of these terms refers to the same type of device.

Lift Chairs are available in a variety of sizes and styles, with numerous optional features. Available in small to large widths, petite to tall heights, cloth, vinyl, or even leather upholstery, and with options including number of positions available, heat, and massage, Lift Chairs can be customized to suit your specific needs.
 
Lift Chair


Who Benefits from a Lift Chair?

Lift Chairs are ideal solutions for anybody who has difficulty transitioning from a seated position to standing due to limited mobility or balance issues. However, the benefits extend far beyond assistance simply sitting down and standing up.

With optional heat and massage features, Lift Chairs provide therapeutic benefits to those with stiff and sore joints, back pain, arthritis, and a variety of other conditions. They provide excellent, affordable alternatives to expensive bathtub modifications for those who require heat and massage therapy.

Lift Chairs can be used for more than just reclining while watching your favorite television programs. Whether you like to use a computer or telephone, read books or magazines, or engage in a number of other recreational activities, the variety of positions available from your lift chair can comfortably accommodate. Many individuals even opt to sleep in their Lift Chairs rather than in their beds because of the variety of positions available. Most models can be reclined to a flat position, but can also be modified to different angles and elevations for maximum comfort.  For individuals who must keep their legs elevated while they sit or sleep, Lift Chairs are an ideal solution.

Even individuals who have had surgery in their shoulders, arms, or other areas can benefit from a lift chair.


Lift Chair Position Guide



  
2-Position
TV Recline
The 2-position TV recline is achievable on all Lift Chairs. This is a comfortable position for performing many relaxing activities including reading, watching TV, working on your tablet or for conversation with family and friends.

3-Position
Full Recline
The 3-position full recline is available on most Lift Chair models and puts you in a position ideal for napping or relaxing.

Infinite-Position
Sleep Recline
The infinite-position sleep recline is perfect for taking a nap - whether quick or extended - or even for a full night's sleep. Infinite-position Lift Chairs enable the backrest and footrest to move independently from one another so that a variety of positions can be reached.

Trendelenburg Position
The Trendelenburg position, available on the elevates one's feet higher than his or her head for increased comfort and relaxation.

Zero-Gravity Position
The zero-gravity position, which can be reached on infinite-position Lift Chair models, positions one's thighs and lower legs higher than his or her torso.




Two Way or Two Position Lift Chairs

A Two Position Lift Chair is limited to a slight recline of about 45°, and can recline to any position in-between straight and reclined making it technically not limited to just two-positions. Two Position Lift Chairs are perfect for those who don’t need a full recline.

2 Position Lift Chair


2 Position Lift Chair in Vinyl Fabric


Three Way or Three Position Lift Chairs

A Three Position Lift Chair can almost reach a full recline (it does not achieve a perfect horizontal line, there is a slight "V" where the back and seat meet) and can recline to any position in-between straight and its fully reclined position.

3 Position Lift Chair


3 Position Lift Chair in Rosewood Color



Infinite Position

An Infinite Position Lift Chair is capable of achieving a fully reclined position. Infinite position lift chairs have dual motors, one for the back and one for the legs, which allows for an "infinite" amount of positions that can be achieved and also allow the user to have their feet higher than the heart.

Infinite Position Lift Chair
Daydreamer Lift Chair by Golden Technologies
Cloud Lift Chair


Where can you get a Lift Chair?

There are many places to purchase a lift chair, but we recommend working with a professional to determine the best type. With the wide range of sizes, features, and designs, the options can become overwhelming and you may end up with a Lift Chair that does not suit your needs adequately.

An expert can work with you to determine more than just the right color to suit your decor – he or she will ask questions such as:

  • Do you frequently eat or drink in the chair? If so, vinyl or leather upholstery may be ideal as it will be easier to clean

  • Do you have a pet that will be sitting in the chair with you? If so, you may require a wider width to accommodate both you and your furry friend

  • Will you be sleeping in your chair? If so, comfort is extremely important – some companies even offer mattresses compatible with lift chairs to maximize your comfort level through the night

  • Will you be spending extended periods of time in your Lift Chair, or will it be used only for relaxation and watching television? For limited-use, a two-position Lift Chair may be adequate. For long periods of use, a 3-position or infinite-position Lift Chair may be preferable to ensure comfort over long periods of time

  • What is your weight? Lift Chairs are designed to handle a wide range of weight thresholds, so finding one to suit your specific needs is imperative to ensure your safety while using the device

  • Do you currently have a favorite reclining chair that the Lift Chair will be replacing? If so, information about your current chair can help the specialist choose a Lift Chair with similar features to make your transition as comfortable as possible

  • How much space do you have for the Lift Chair? Some units occupy more space, while others are designed to be more compact and can be placed close to the walls to prevent them from obstructing your living area

  • Will you need the Lift Chair permanently, or only temporarily? Many companies offer Lift Chairs for rental use while recovering from a surgery or visiting a relative

Where to buy a lift chair or where can I buy a lift chair?

You can buy Lift Chair at Primo Medical Supplies a Medical Equipment Store located in San Antonio Texas. We are located at 7515 Grissom Rd Suite 107 San Antonio Texas 78251. You can also visit our website at www.sanantoniomedicalequipment.com. For more information you can call the customer service at 210-519-5311.

Where to rent a lift chair or where can I rent a lift chair?

You can rent a Lift Chair at Primo Medical Supplies a Medical Supply Store located in San Antonio Texas. We are located at 7515 Grissom Rd Suite 107 San Antonio Texas 78251. You can also visit our website at www.sanantoniomedicalequipment.com. For more information you can call the customer service at 210-519-5311.



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