Pride Scooter/POVs ® Medicare Product Planning Guide - January 2015 Group 1 - Standard K0800 Allowable: $1236.75 ---------------------------------------------------------- Go-Go Elite Traveller w/12 AH batteries (3 & 4-Wheel) [SC40E, SC44E] Go-Go ES 2 [S81] ---------------------------------------------------------Group 1 - Heavy Duty K0801 Allowable: $1993.91 ---------------------------------------------------------- Victory 10 (3 & 4-Wheel) [SC610, SC710] Go-Go Sport (3 & 4-Wheel) [S73, S74] ---------------------------------------------------------Group 1 - Very Heavy Duty K0802 Allowable: $2256.47 ---------------------------------------------------------- Maxima (3-Wheel) [SC900] ---------------------------------------------------------Group 2 - Very Heavy Duty K0808* Maxima (4-Wheel) [SC940] Allowables listed do not reflect those in Competitive Bid Areas where reimbursement is based on the Single Payment Amount. * Group 2 POVs must be billed to Medicare as either a beneficiary requested upgrade with a properly executed ABN, or as an upgrade at no additional charge to the beneficiary. PPRC/PPG/POV/R-1-5-15
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