Q1. Will Medicare pay for repairs to a piece of equipment that was obtained prior to the client being covered by Medicare?
A1. The beneficiary must meet current Medicare reimbursement criteria for the equipment in order to be repaired if Medicare did not purchase the item. If it was obtained prior to Medicare coverage or if another payer purchased the equipment, the supplier must obtain the required documentation to verify coverage and to determine if the item is covered by a warranty.
Q2. How is a product replaced prior to the 5-year life expectancy?
A2. The replacement of a product before the 5-year life expectancy can only be done if the item is irreparably damaged, for example by a natural disaster such as fire, flood, etc. Replacement due to wear and tear before the 5-year lifetime is not covered. Refer to the September 2003 articles for additional information.
Q3. For Repairs, may travel time be charged using the A9900 procedure code for DME supply or A9270 non-covered service?
A3. Travel time is included in the reimbursement of parts and labor and MAY NOT be paid separately. If a supplier chooses to bill separately, code A9901 (DME delivery, set-up, and/or dispensing service component of another HCPCS code) must be used. This code is autodenied as a CO denial. HCPCS Code A9270 must not be used.
Q4. Is a re-manufactured part with a warranty from the manufacturer considered new or used equipment?
A4. A re-manufactured part with a warranty is considered used. It should be billed using the appropriate modifier, UE.
Q5. A beneficiary is prescribed a new power wheelchair to replace his existing chair, which is 8 years old. It is impossible to repair the old unit for less than 50% of the replacement allowable for a new chair. Assuming the repairs carry a limited warranty, would the patient ONLY qualify for repairs or would the 5-year useful lifetime apply?
A5. If a chair has reached its 5-year life expectancy, the chair can be replaced. However, if a chair reaches its 5-year life expectancy, is in good working order, and meets the beneficiary’s medical needs, it should not automatically be replaced.