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Medicare Group 4 Wheelchair ? HCPCS K0884 Coverage

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    Medicare Group 4 Wheelchair ? HCPCS K0884 Coverage

    Hello CareCure folks,

    C-5 Quadriplegic, 9 years post injury, getting ready to purchase my third power wheelchair. I?ve been through the ins and the outs of this screwed up insurance/medical system to know that it?s never easy to get exactly what you need and that Medicare always pays for the least expensive option, but figured I?d throw this out there and see if anyone has been successful.

    Will Medicare pay for a portion of a Group 4 wheelchair. I know Group 4 wheelchairs are not covered under Medicare guidelines and HCPCS codes, but will they at least reimburse me for the Group 3 wheelchair that I?m covered for and let me pay the difference.

    I am a heavy wheelchair user (not heavy in weight, but usage) that uses my wheelchair as both my primary transportation to get around town (outdoors) but to also live my life indoors. I need a wheelchair that will hold up to rugged outdoor terrain. The current wheelchair I have my sights on is the Permobil F5 with HCPCS Code K0884. My DME provider is saying this chair won?t be covered and that I have to get the lesser F3, and what I?m saying is why can?t I just pay the difference out-of-pocket between the two.

    Is there a way to make this happen?

    Appreciate any insight? Successes or failures that you might all have.
    I am the Quad in Quadomated. Come read about Life and Technology through the Eyes of a Quad

    Maybe. That's a big maybe. I don't know what "group 4" or "group 3" is all about, but I do know what might help you is the Advanced Beneficiary Notice/Notification process. ABN is essentially a document the provider gives you to sign with the anticipated costs, what portion Medicare may cover, and what portion may be left over. You agree to pay the remaining portion above and beyond your normal 20% co-pay. I would ask your supplier about this. This is how I have gotten at least "some" help from Medicare on items they don't fully cover.
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty


      Here is some info that I copied from the link below:

      Understand that if you want additional features or upgrade that your health does not require, you can still get some coverage from Medicare for your upgraded DME, if you agree to pay more. Here’s how this works. If your supplier think that Medicare may not pay for additional features, the supplier should have you sign a waiver form called an Advance Beneficiary Notice (ABN) before you get the items. On the ABN, you must check the box stating you want the upgrades and will agree to pay their full cost if Medicare ends up denying coverage for them when the supplier submits the bill. Even if Medicare does refuse the upgrade, it will still pay the amount it would have paid for the basic model of the equipment. Also, you can appeal the denial if you believe your health required the upgrade.

      If Medicare refuses to cover upgrades and the supplier failed to provide you an ABN, you do not owe the supplier for the added features.
      You will find a guide to preserving shoulder function @

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        Not sure if there is any way to get the F5 via Medicare as the base is as they say a group 4. You may have to get an F3 with upgrades.

        Have you looked at the Frontier V6 Urban? I believe it is fundable and has options for bigger motors and AT tires.

        I have the X5 and it is great. May be an option worth looking at.