Medicare will usually only pay for the most basic form of DME you need to help your medical condition. Medicare will not typically pay for special features or upgrades for your durable medical equipment (DME) items. For example, Medicare will cover a power wheelchair that your health calls for to get around the house, but not added features such as a special kind of backrest or a tilt function for the seat that your health does not require.
Keep in mind Medicare will only pay for special features or upgrades for your durable medical equipment (DME) items if your provider says your condition justifies them and includes them in your DME order or prescription. For example, if your provider states you do not have the strength or balance to lift a standard walker without wheels, Medicare should pay for a model with wheels.
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.