What is the process for determining replacement value on Capped Rental equipment in terms of whether or not it is more costly to repair or replace equipment?
In the Medicare Carriers Manual 2100.4A states, A. Repairs – Repairs to equipment which a beneficiary is purchasing or already owns are covered when necessary to make the equipment serviceable. If the expense for the repairs exceeds the estimated expense of purchasing or renting another item of equipment for the remaining period of medical need, no payment can be made for the amount of the excess. (See subsection C where claims for repairs suggest malicious damage or culpable neglect). Information needed by CIGNA with the claim is: • breakdown of the estimated charges for the repairs to make the equipment serviceable. • age of the equipment • statement explaining the nature of the damage, wear, etc We take into consideration the age of the equipment, which should not be less than the useful lifetime of the equipment, and the breakdown of the repair charges necessary to make the equipment serviceable. The repair estimates would be compared to the fee schedule for the purchase of the pie
