Capped Rental with MSP

Medicare as secondary payer can, under no circumstances, pay more than Medicare would have paid as a primary payer. If the primary insurance pays for the lump sum purchase of a capped rental item (except complex rehabilitative power wheelchairs), Medicare cannot make a secondary payment. Medicare would not make a primary payment; therefore, a secondary payment could not be made for the lump sum purchase of a capped rental item.

Complex rehabilitative power wheelchairs are the only exception to capped rental guidelines. Medicare as primary payer could pay for purchase or rental. When Medicare is secondary payer, the primary insurance must be filed first and Medicare would process the claim secondary.

Medicare may not pay secondary benefits when the primary payer pays the supplier's charges in full, or when the supplier is either obligated to accept, or voluntarily accepts, the primary payer's payment as payment in full.
 

Last Updated Apr 19, 2018