Does Medicare Cover It? Coverage Lists, HCPCS Codes and How Reimbursement Actually Works
Peak Health and Wellness sells new medical equipment directly to you at published cash prices. We don't bill Medicare, Medicaid or private insurance — and for a great many people, that turns out to cost less, not more. This guide tells you what Medicare typically covers, what it doesn't, the HCPCS code you'll need for every major category, and how to file for reimbursement yourself.
Why We Started Peak Health and Wellness
We started this company because of a pattern we kept running into, and could not stop thinking about.
Someone is discharged from the hospital, or a parent's condition changes, and the family is referred to a durable medical equipment provider that bills Medicare or Medicaid. The equipment shows up. They're told not to worry — it will all be processed for them.
Then, weeks later, a bill arrives. The claim was denied, or only partly paid, and the amount owed is several times what the identical item sells for online. Nobody explained the coverage rules up front. The person least equipped to evaluate any of it — someone in the middle of a health crisis, or a family member managing one — is the person left holding the invoice.
We saw that happen often enough that it stopped looking like bad luck and started looking like the way the system works. We thought it was unjust, and we wanted to do something about it.
So Peak Health and Wellness does the opposite. Every price is published before you buy. Every product is brand new. We tell you plainly what Medicare does and doesn't cover — including on this page, where the honest answer costs us sales. And because we're not in the insurance chain at all, there's no surprise invoice six weeks later. What you see at checkout is what you pay.
Should You Rent Through Medicare, or Buy Outright?
This is the most consequential decision on this page, and most people are never told they have a choice.
For equipment like wheelchairs, hospital beds, therapy mattresses and patient lifts, Medicare uses a capped rental. You rent month after month, and only after 13 months of continuous rental does the title transfer to you. Oxygen equipment runs on a separate 36-month schedule.
Two things follow:
- You pay a coinsurance share every single month — 20% of the monthly rental, for 13 months, on top of your Part B deductible. It adds up quietly.
- What arrives is used. Rental equipment is exactly that — it has been in other patients' homes before yours, then returned, cleaned and re-issued. You inherit whatever wear those years left behind, and the warranty clock started long before you got it. You are paying, month after month, for someone else's old equipment.
Everything we sell is brand new, current model year, with the full manufacturer warranty starting the day it ships to you. If you know you'll need the equipment for more than a few months, buying outright is frequently cheaper over the life of the item — and you own it on day one instead of month thirteen.
When Buying Direct Costs Less — and When It Doesn't
Most retailers in this category will tell you they always beat the covered route. That isn't true, and we'd rather you hear it from us than find out later.
Here is the arithmetic nobody explains. When a supplier accepts assignment, Medicare's 20% coinsurance is calculated on the Medicare-approved amount — not on whatever the supplier's sticker price says. A supplier accepting assignment legally cannot bill you above the approved amount. So if you're fully qualified, your deductible is met, and your supplier accepts assignment, you're paying 20% of a controlled price. No cash retailer can beat an 80% subsidy, and we won't pretend otherwise.
Worked example — a standard wheeled walker
Medicare's approved amount for a folding wheeled walker (E0143) runs roughly $56 to $126 depending on where you live. A comparable walker from us is around $40, plus $7.95 shipping.
| Your situation | Through a covered supplier | Through Peak |
|---|---|---|
| Part B deductible not yet met | $56–$126 (you pay the full approved amount until the $283 deductible is satisfied) | $47.95 |
| Deductible met, supplier accepts assignment | $11–$25 (20% coinsurance) | $47.95 |
| Claim denied, or you don't qualify | Full supplier charge | $47.95 |
In the middle row, the covered route is the better deal. We'll say so.
Where buying direct genuinely wins
The advantage is real, but it's specific. These are the situations where it holds:
- The item isn't covered at all. Grab bars, transfer benches, shower chairs, raised toilet seats, stairway lifts, total electric beds, the chair half of a lift chair, geri chairs. There is no coinsurance to compare against — our price is the only price, at any supplier.
- You don't meet the coverage criteria. The rules are strict. Hospital beds require documented positioning needs; scooters must be needed inside the home, not just outdoors. Plenty of people who genuinely need equipment don't qualify on paper.
- Your deductible hasn't been met. At $283 a year, that's most people for a good part of the year — and on items under about $150, that's usually enough to tip the math our way.
- You already have one, and it's due to be replaced. See below.
- Your covered allotment isn't enough. See below.
- The rental math turns against you. Thirteen months of coinsurance on a capped rental — or thirty-six on oxygen — can exceed the purchase price, and every one of those months you are paying for used equipment that came out of someone else's home.
- You're under 65. See below.
- You need it now. No physician order, no Certificate of Medical Necessity, no claim, no three-week wait. Most orders ship in 1–2 business days.
If you're under 65, the gap can last more than two years
Medicare isn't strictly a 65-and-over program — but the paths in before 65 are narrow, and one of them involves a wait most people don't see coming.
Under 65, you generally qualify only if:
- You've been receiving Social Security Disability (SSDI) benefits for 24 months. And SSDI itself has a five-month waiting period before payments begin — so the clock from disability determination to Medicare coverage is closer to 29 months.
- You have ALS, which waives the 24-month wait entirely — Medicare begins as soon as SSDI payments do.
- You have End-Stage Renal Disease, where coverage generally begins around the third month of regular dialysis, or following a kidney transplant.
That 29-month gap is the hard part. Someone becomes disabled and needs a wheelchair, a hospital bed, a commode, a transfer bench — immediately — and Medicare will not be there for roughly two and a half years. Private insurance may or may not cover durable medical equipment, and often doesn't.
The same applies to anyone under 65 who simply isn't on SSDI: someone recovering from surgery or a fracture, a younger person with a chronic condition, a child with a disability, or a family member buying equipment for a parent rather than navigating the parent's benefit. For a six-week post-surgical recovery, the whole apparatus — physician order, Certificate of Medical Necessity, enrolled supplier, capped rental — is enormous overhead for a short-term need.
If that's your situation, there is no coinsurance to weigh against our price. Buying outright isn't the cheaper option — it's the only option, and you should at least get a fair price and new equipment for it.
The five-year replacement rule
Medicare assigns every piece of durable medical equipment a reasonable useful lifetime of at least five years, counted from the date you first used it. Inside that window, Medicare will generally only replace an item if it was lost, stolen, damaged beyond repair by a specific incident, or if your medical condition changed enough that the equipment no longer meets your needs.
Normal wear and tear does not qualify. If your walker simply wears out in year three, Medicare's answer is repair, not replacement. That's the position a lot of our customers find themselves in — with a worn item, two years left on the clock, and no path forward through their benefit.
When what you're issued isn't enough — or isn't what you wanted
Two situations come up constantly, and neither is a coverage problem you can appeal your way out of.
The monthly allotment runs short. Where incontinence supplies are covered — that's Medicaid, not Medicare, and it varies by state — coverage comes with a hard monthly cap. New York, for example, allows up to 250 disposable briefs or liners per month, roughly eight changes a day. If your actual need is nine or ten changes a day, you run out before the month does. Buying the extra packs outright is usually the only option, and it's a normal thing to do.
What you were issued is the basic model. Covered equipment is specified to meet a medical need, not a preference. If you were issued a standard walker and you want a lighter one with a seat and better brakes, or a wheelchair that isn't the heaviest option in the catalog, that upgrade is yours to buy. Many of our customers keep the covered item as a backup and buy the one they actually want to use.
Why you may be sent to several different suppliers
If you've ever been told to go to one company for a walker and a different company across town for a wheelchair, you weren't imagining it.
From 2011 through 2023, Medicare ran a DMEPOS Competitive Bidding Program. Suppliers submitted bids by product category and by geographic area, and only the winners in each category could furnish those items to Medicare beneficiaries in that area. The intent was to bring down what Medicare was paying. The practical effect for patients was that a single household often had to deal with several suppliers, each covering a different slice of what they needed.
Current status, as of 2026: the program is in a temporary gap period. The last contracts — Round 2021 — expired on December 31, 2023, and CMS has not awarded a new round since. During this gap, any Medicare-enrolled DMEPOS supplier may furnish covered items to beneficiaries. CMS has published planning materials for a Round 2028, so the category-by-category structure is expected to return.
In the meantime, many suppliers still operate within the product lines they built their business around during the bidding years, so you may still find yourself sent to more than one place.
Does Peak Health and Wellness Bill Medicare, Medicaid or Insurance?
No. We are not an insurance company and do not sell, broker or enroll anyone in any insurance or Medicare plan. We also cannot accept insurance as payment or bill your carrier, because we do not contract with insurance companies. Payment by credit or debit card is required at the time of purchase.
One thing we want you to know before you buy, because nobody told our early customers.
Medicare pays for durable medical equipment only when it comes from a supplier holding a Medicare DMEPOS supplier number. Peak Health and Wellness is not a Medicare-enrolled supplier. That means a reimbursement claim you file for equipment purchased from us may be reduced or denied even when the item itself is a normally covered category and you personally qualify.
So please treat anything you buy here as an out-of-pocket purchase. If reimbursement is essential to you, call 1-800-MEDICARE (1-800-633-4227) first, give them the HCPCS code from the tables below, and ask specifically how a patient-submitted claim from a non-enrolled supplier would be handled in your case.
We'd rather tell you this now and lose the sale than have you find out in six weeks. That's the whole reason we exist.
Quick Reference: What Medicare Typically Covers — and What It Doesn't
This is the list most people are looking for. A few of these surprise almost everyone.
Typically covered as durable medical equipment
Covered under Medicare Part B when prescribed as medically necessary for use in the home, supplied by a Medicare-enrolled supplier, subject to the coverage criteria for each item.
| Item | Common HCPCS codes |
|---|---|
| Walkers and rollators | E0135, E0143, E0149 |
| Canes and crutches | E0100, E0105, E0110–E0114 |
| Commode chairs | E0163, E0165, E0168 |
| Manual wheelchairs | K0001–K0009 |
| Power wheelchairs and scooters | Coded by group and capacity |
| Hospital beds — fixed height, variable height, semi-electric | E0250, E0251, E0255, E0260, E0261 |
| Patient lifts | E0630, E0635, E0639 |
| Pressure-reducing air mattresses | E0277 |
| Oxygen concentrators | E1390, E1392 |
| CPAP and BiPAP devices | E0601, E0470 |
| Nebulizers with compressor | E0570 |
| Home suction pumps | E0600 |
| The seat lift mechanism in a lift chair — not the chair | E0627, E0629 |
Typically not covered
These are generally classified as comfort, convenience, self-help or home-modification items rather than durable medical equipment — regardless of how strongly a clinician recommends them.
| Item | Why not |
|---|---|
| Grab bars | Comfort/convenience item |
| Tub and shower transfer benches | Bathtub and toilet seating is excluded |
| Shower chairs and bath seats | Bathtub and toilet seating is excluded |
| Raised toilet seats and toilet safety frames | Toilet seating is excluded |
| Stairway lifts and elevators | Named exclusion |
| Wheelchair ramps, widened doorways, walk-in tubs | Home modifications, not DME |
| Total electric hospital beds (E0265, E0266) | Powered height adjustment is a convenience feature |
| The chair portion of a lift chair (A9270) | Furniture; only the lift mechanism may be covered |
| Seat lifts placed over a toilet (E0172) | Specifically non-covered |
| Geri chairs and recliners | Furniture |
| Incontinence pads and adult briefs | Disposable supply |
| Compression stockings (most situations) | Disposable supply |
| Scooters needed only outside the home | DME must be needed in the home |
| Air conditioners, exercise equipment | Comfort/convenience items |
If your item is on the second list, the coverage question is already settled — nobody is getting it paid for, at any supplier, through any provider. The only real question left is where to get a good one at a fair price without being walked through a claims process that was never going to succeed.
A note on Medicaid. Medicaid is administered state by state, and coverage for durable medical equipment varies considerably between states — some cover items Medicare won't. The lists above describe Medicare. For Medicaid, contact your state Medicaid office directly.
HCPCS Codes by Product Category
A HCPCS code is the identifier Medicare uses for a specific piece of equipment. When you call 1-800-MEDICARE, it's the first thing they'll ask for. Find your category below.
Lift Chairs and Recliners
The most misunderstood category on this page. Medicare treats a lift chair as two separate things: the motorized lifting mechanism, and the chair it's built into.
| Code | What it covers |
|---|---|
| E0627 | Seat lift mechanism, electric, any type — the part Medicare may cover |
| E0629 | Seat lift mechanism, non-electric, any type |
| A9270 | The chair / furniture portion — billed separately and not covered |
| E0172 | Seat lift placed over or on a toilet — not covered |
Even in the best case, Medicare reimburses toward the lift motor — never the recliner. Anyone advertising a "free lift chair through Medicare" is not describing how the benefit works. Since the furniture is your cost either way, buying the whole chair outright at a cash price is often the more sensible route.
Wheelchairs, Power Chairs and Scooters
| Code | Description |
|---|---|
| K0001 | Standard wheelchair |
| K0002 | Standard hemi (low seat) wheelchair |
| K0003 | Lightweight wheelchair |
| K0004 | High strength, lightweight wheelchair |
| K0005 | Ultralightweight wheelchair |
| K0006 | Heavy duty wheelchair |
| K0007 | Extra heavy duty wheelchair |
| K0009 | Other manual wheelchair / base |
Power wheelchairs and scooters are coded individually by group and weight capacity. Call us at (877) 732-5495 and we'll pull the exact code for the model you're considering.
Hospital Beds and Mattresses
| Code | Description |
|---|---|
| E0250 | Hospital bed, fixed height, with side rails, with mattress |
| E0251 | Hospital bed, fixed height, with side rails, without mattress |
| E0255 | Hospital bed, variable height (hi-lo), with side rails, with mattress |
| E0260 | Hospital bed, semi-electric (head and foot adjustment), with mattress |
| E0261 | Hospital bed, semi-electric, without mattress |
| E0265 | Hospital bed, total electric (head, foot and height) — not covered |
| E0266 | Hospital bed, total electric, without mattress — not covered |
| E0277 | Powered pressure-reducing air mattress |
| E0271 | Mattress, innerspring |
The total-electric surprise. Medicare's coverage policy states plainly that a total electric hospital bed is not covered, because the powered height adjustment is considered a convenience feature. Semi-electric beds — head and foot by motor, height by hand crank — can be covered when the medical criteria are met.
Total electric is also the bed most caregivers actually want, because raising the deck saves your back during transfers and changes. So the feature you need most is the one Medicare won't pay for — which is a real argument for buying rather than renting.
Coverage for a hospital bed generally requires documentation that you need positioning an ordinary bed can't provide — to alleviate pain, to keep the head elevated more than 30 degrees for conditions such as congestive heart failure, COPD or aspiration risk, or to use traction equipment. Variable-height beds add a transfer requirement; semi-electric beds add a need for frequent or immediate repositioning.
Patient Lifts and Slings
| Code | Description |
|---|---|
| E0630 | Patient lift, hydraulic or mechanical, includes seat, sling, straps or pads |
| E0635 | Patient lift, electric, with seat or sling |
| E0636 | Multipositional patient support system with integrated lift |
| E0639 | Patient lift, moveable room to room, with disassembly and reassembly |
| E0621 | Sling or seat, patient lift, canvas or nylon |
| E0625 | Patient lift, bathroom or toilet, not otherwise classified |
Walkers, Rollators and Commodes
Both of these categories are normally covered by Medicare when prescribed as medically necessary — a point worth knowing before anyone tells you otherwise.
| Code | Description |
|---|---|
| E0135 | Walker, folding (pickup), adjustable or fixed height |
| E0143 | Walker, folding, wheeled, adjustable or fixed height (rollator) |
| E0149 | Walker, heavy duty, wheeled, rigid or folding, any type |
| E0163 | Commode chair, mobile or stationary, with fixed arms |
| E0165 | Commode chair, mobile or stationary, with detachable arms |
| E0168 | Commode chair, extra wide and/or heavy duty (bariatric) |
Oxygen and Respiratory Equipment
| Code | Description |
|---|---|
| E1390 | Oxygen concentrator, single delivery port, 85% or greater concentration at prescribed flow rate |
| E1392 | Portable oxygen concentrator, rental |
| E0601 | Continuous positive airway pressure (CPAP) device |
| E0470 | Respiratory assist device, bi-level, without backup rate (BiPAP) |
| E0570 | Nebulizer, with compressor |
| E0600 | Respiratory suction pump, home model, portable or stationary, electric |
Oxygen equipment sits on the 36-month rental schedule rather than the 13-month one, which makes the rent-versus-buy math especially worth running.
Don't see your product? Call (877) 732-5495 and we'll look up the exact HCPCS code for the model you're considering — whether or not you buy it from us.
How to File a Reimbursement Claim Yourself
If you've confirmed with Medicare that your situation may qualify, here is the sequence:
- Get a prescription from your physician stating the equipment prescribed along with your diagnosis. Some equipment additionally requires a Certificate of Medical Necessity.
- Call 1-800-MEDICARE (1-800-633-4227) before purchasing. Give them your Medicare ID and the HCPCS code, and ask specifically how a patient-submitted claim from a non-enrolled supplier would be handled.
- Complete your purchase and print your Peak Health and Wellness receipt and order confirmation.
- Print and complete Medicare form CMS-1490S, the Patient's Request for Medical Payment. Download the printable CMS-1490S DME claim packet (PDF) — it includes the form itself, line-by-line instructions, and the chart of where to mail it based on the state you live in.
- Submit all three together — prescription, itemized receipt and completed claim form — to the Medicare contractor for your state, at the address listed in that packet.
One instruction from CMS worth reading carefully. The 1490S packet tells you to "explain in detail your reason for submitting the claim," and gives this as its example: a statement notifying the Medicare contractor that your supplier "refused or is unable to file a claim for a Medicare-covered service and/or is not enrolled with Medicare."
That second part describes us. Include that statement, keep copies of everything you send, and allow at least 60 days for processing.
CMS also states plainly on that same page that you can reduce your out-of-pocket cost by using a supplier that is enrolled in Medicare and bills Medicare directly. We think you should know that before you buy from us, not after.
Where a claim is approved, Medicare Part B generally pays up to 80% of the Medicare-approved amount after your annual Part B deductible has been met. A secondary or Medigap policy may cover part or all of the remaining 20%. The approved amount is set by Medicare's fee schedule and may differ from the price you paid.
What You Get Buying Direct From Peak
- Everything is brand new. Never rented, never in anyone else's home.
- Full manufacturer warranty beginning the day your order ships.
- You own it immediately — no 13-month capped rental, no 36-month oxygen schedule.
- One place for everything — mobility, respiratory, beds, bath safety and daily supplies, in a single order.
- The price is the price. No claim to be denied, no invoice six weeks later.
- Current models from leading brands — Invacare, Drive, McKesson and others.
- Free shipping on orders over $95, with most orders shipping in 1–2 business days.
- Real support after the sale. Email [email protected] and we'll take care of it.
Still Have Questions?
Call (877) 732-5495 or email [email protected]. We're glad to look up a HCPCS code, talk through rent-versus-buy for your situation, or help you find the right model — even if you decide to go somewhere else.
Peak Health and Wellness is a retailer of new durable medical equipment. We are not an insurance company, insurance agent or broker, and we do not sell, compare or enroll anyone in any health insurance, Medicare or Medicaid plan. We are not enrolled as a Medicare DMEPOS supplier and do not bill Medicare, Medicaid or private insurance. This page is general information only and is not medical, legal or billing advice. Coverage determinations are made solely by Medicare, Medicaid or your insurer based on your individual circumstances, and Medicaid coverage varies by state. HCPCS codes and coverage policies are current as of August 2026 and are subject to change — always verify with Medicare at 1-800-633-4227 before purchasing.