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IC38 Upgrades & Funding: How? When? and Can I Provide the Option?

Program ID Number: CRS000708
CEU Course ID: P290.15
Webinar Length of Time: 1.0 hour

Link to view the lecture presentation:


There seems to be a lot of confusion regarding equipment upgrades.  The apprehension seems to stem from when you can provide an upgrade based on funding source and on what is actually considered an upgrade. It s time to put some myths to rest and review what is actually allowed and/or what questions you need to ask. Although upgrades are primarily seen as a financial discussion, clinicians have a key role in both education and documentation.


Learning Objectives:



Claudia Amortegui, MBA
The Orion Consulting Group, Inc.
Denver, CO
United States

Claudia Amortegui is the president of The Orion Group, a consulting company specializing in the reimbursement of rehab equipment. She has been consulting for over 16 years, but first worked on all sides of the industry: with Medicare, a manufacturer, and a provider. She has been published numerous times in national industry publications, and her clients consist of manufacturers, providers, referrals and funding sources. This extensive and diverse experience makes Claudia, and her team, uniquely qualified to assist people in understanding the reimbursement process.

Note: Faculty for this activity have been required to disclose all relationships with any proprietary entity producing health care goods or services, with the exemption of nonprofit or government organizations and non-healthcare related companies.

* No conflicts have been disclosed.



  1. CMS Medicare Claims Processing Manual (Publication 100-4), Chapter 20 and Chapter 30.
  2. DME MAC Jurisdiction C Supplier's Manual - Chapter 3, Section 9 Advance Beneficiary Notice (documentation the same for all Jurisdictions, however different Chapters & Sections - same title).
  3. CMS Local Coverage Determination (LCD) for Wheelchair Options/Accessories (L11451), Updated 03/07/14.


Updated | 06.25.2015