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Medicare Coverage of Traction Equipment
Medicare will cover most of the cost of traction equipment if you have an illness or condition that requires traction equipment to be available in your home for therapy. Medicare payment for the traction equipment is subject to the requirement that the equipment is medically necessary and reasonable for treatment of an illness or injury and/or to improve the functioning of a body part. To ensure that Medicare pays for the traction equipment, you must follow the steps below:
- Only your doctor can prescribe the equipment for you, so do not order anything until you have visited your doctor, no matter what the sales person tells you.
- The doctor must document your need for the traction equipment by writing the information in your medical records and by giving you a signed and dated order (prescription) for it.
- The supplier must receive the order before Medicare is billed and it must be kept on file by the supplier.
- If you receive your Medicare through a one of Medicare Advantage Plans (like a HMO or PPO) it is likely you will have to follow the plan's steps for approval and purchase. Make a point of calling your plan's customer service number and ask about their steps for coverage of traction equipment.
Traction Equipment Styles and Sizes
Traction equipment comes in a variety of styles and sizes. Your doctor will order the equipment that is specific to your injury or condition. There are two main types of traction equipment:
- Cervical traction devices: Cervical traction devices can be free standing, attach to a headboard, or have an over-the-door mechanism. Medicare payment will be based on the allowance for the least costly medically appropriate alternative—a device that attaches over a door.
- Other types of traction devices: These devices are covered under Medicare when there is a medical need for them. Your doctor must clearly document your need for the equipment and write a prescription for the specific equipment you need. The Medicare payment will be based on the least costly type of equipment that will meet your needs.
Costs For Traction Equipment
How much you pay will depend on whether or not you have Part B coverage and where you buy your equipment. However, in general, if you are enrolled in Medicare Part B:
- You will pay 20% of the approved Medicare amount, after you have met your yearly deductible.
- You will pay less if you buy from a supplier who accepts assignment. A supplier who accepts assignment has agreed not to charge more than the Medicare-approved amount and will not ask for more than your 20% copay.
- You might not have a copay if you have Medigap/Medicare Supplemental Insurance.
- You may owe little to nothing, if you receive you Medicare through a Medicare Advantage Plan, depending on the plan you have and your benefits with that plan.
It is important to do your homework. Read about the factors that affect how much coverage you will receive. Make sure all paperwork is completed correctly and that you buy your equipment through an approved supplier that accepts assignment.
Ordering Traction Equipment through a Medicare-Approved Provider
You will save money if you order your item from a Medicare-approved provider. Suppliers must meet strict standards to qualify as a Medicare supplier and will have a Medicare supplier number. You may also buy your traction equipment from any store that sells them. However, if the supplier from which you order your traction equipment is not enrolled in Medicare, Medicare will not pay for the equipment.
Things you should think about before you choose a supplier:
- There are two types of Medicare suppliers: participating suppliers, and those who are enrolled but have chosen not to participate.
- Participating suppliers must accept assignment, which means they will not charge more than the Medicare-approved amount for the traction equipment.
- A Medicare-approved provider who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15% above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up the equipment. In this situation Medicare will send the reimbursement directly to you. However, be prepared to wait; it may take a couple of months to receive payment.
- If you receive your Medicare coverage through a Medicare Advantage Plan (like a HMO or PPO), it is likely that the plan will have its own steps for equipment purchases. In addition, the plan may have restrictions on the supplier from which you can buy. It is important to know that your health plan must supply at least what Medicare covers—they cannot supply less. Depending on your plan, you may actually receive more coverage than you would get with Medicare alone. It is wise to call your Medicare Advantage Plan's customer service and ask about your coverage before you order your traction equipment.
Medicare Part B and Traction Equipment
You must have Medicare Part B coverage and your doctor must have documented your need for the equipment and written you an order (prescription) for the equipment. There is a wide range of traction equipment available and the specific coverage criteria will vary. Your doctor or supplier will know what is necessary to qualify for the type of equipment that they prescribe for you. In order for any item to be covered under Medicare, it has to meet the test of durability. Medicare will pay for medical equipment when the item:
- Withstands repeated use
- Is used for a medical purpose
- Is useless in the absence of illness or injury
- Is for use in the home
To qualify for traction equipment, you:
- Must have a musculoskeletal or neuralgic impairment requiring traction equipment.
- Must have been shown how to use the device and have demonstrated that you can tolerate it.
- Must meet any other necessary criteria, depending on the particular piece of equipment your doctor has ordered.