Certificate of Medical Necessity

What is a Certificate of Medical Necessity?

Medicare provides reimbursement for many types of durable medical equipment. They will typically cover up to 80% of the cost of most types of medical equipment, such as eye glasses, adjustable beds, and mobility scooters.

Most enrolled in Medicare are eligible to receive this coverage, but must provide a doctors prescription. Some types of medical equipment, like lift chairs, require a Certificate of Medical Necessity in addition to a doctors prescription.

A Certificate of Medical Necessity is simply a more detailed prescription that must be filled out by your doctor. Usually the company that you purchase the equipment from will provide you with the form and fill out the product information section and you must have your doctor fill out the rest.

Lift Chairs

Lift chairs are only partially covered by Medicare and will require a Certificate of Medical Necessity.

Not all lift chairs are covered either. In order for the chair to be covered, it must use an electric lifting mechanism that operates smoothly and steadily. The lifting mechanism is the only part of the chair that Medicare will provide reimbursement for, which is usually around $300.

The doctor must answer the following questions on the Certificate of Medical Necessity:

  1. Is the patient suffering from severe hip or knee arthritis?
  2. Is the patient suffering from a serious neuromuscular disease?
  3. Is it impossible for the patient to stand up from any chair in their home?
  4. Once standing, does the patient have the ability to move about independently?
  5. Has medication or therapy been used unsuccessfully to address this condition?

What Else Requires a Certificate of Medical Necessity?

  • Some Kinds of Patient Lifts
  • Wheelchairs and mobility scooters
  • Oxygen supplies and equipment
  • Bone growth stimulators