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    Medicare and Permobil upgrades

    I have been without a power chair for 2.5 years. My previous power chair was authorized by my now secondary insurance ChampVA (I am a beneficiary from my deceased father) back in 2008. Back then I got a Permobil C500VS. Medicare became my primary insurance in 2012, but oddly enough Medicare covered repairs for the that 2008 Permobil. Wanting another Permobil VS, I started fundraising campaigns to upgrade from a Permobil F3 (from what my vendor told me Medicare covers) to a Permobil F5 VS (which I saw as a possibility on the F3's order form). My vendor told me that Medicare has to be billed for the upgrade in addition to the original wheelchair. I let my vendor do some research and they told me that because these two wheelchairs use different HCPCS coeds that an upgrade would not be possible. Is this true? can't I fund the upgrade myself? Thanks in advance for the responses!
    Yours truly,

    Stuck1



    Please help me find a cure for Creutzfeldt-Jakob Disease (CJD) reply to learn more ? Awareness is one step closer to a cure!

    #2
    You got a doc script? Seems like your second ins. would pick up the rest.
    Art

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      #3
      Originally posted by Art454 View Post
      You got a doc script? Seems like your second ins. would pick up the rest.
      My then primary insurance in 2008 said that the chair was "unauthorized purchased", as it was a "luxury good". If I end up going for the F3 that is covered by Medicare the VA will pay what Medicare will not as fare as power seat options. I guess if their somethings I want on the chair that either insurance won't pay I can pay for them with my funds raised.
      Yours truly,

      Stuck1



      Please help me find a cure for Creutzfeldt-Jakob Disease (CJD) reply to learn more ? Awareness is one step closer to a cure!

      Comment


        #4
        An upgrade is possible in the scenario you described. The Permobil F3 is covered by HCPCS code K0861. The F5 is covered by HCPCS code K0884. The rehab provider / supplier / vendor would bill Medicare using the K0861 code. You would then be responsible for the 20% copay and the difference between the K0861 allowable and the supplier's retail charge for the F5.

        If your provider / supplier has questions about how to go about this billing procedure, contact me offline and I can put them in touch with a reimbursement specialist at Permobil.

        Good luck!

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