Medicare Power Wheelchair Coverage Guidelines

Medicare requires that the following criteria must be met in order for your power wheelchair to be covered by Medicare.  Hoveround ensures that this process is followed for each case.  Take this Mobility Exam Packet with you to your doctor to help ensure correct documentation.

1. Physician's Order

The power wheelchair supplier must receive a written order from the treating physician that contains all of the following elements:

  • Patient's name
  • Description of the item that is ordered - e.g. "power wheelchair"
  • Date of the face-to-face mobility examination
  • Pertinent diagnoses/conditions that relate to the need for a power wheelchair
  • Length of  time the power wheelchair will be needed
  • Physician's signature
  • Date of physician's signature

This order must be received by the wheelchair supplier within 45 days after completion of the physician's face-to-face examination, and prior to delivery of the power wheelchair.

Based on the physician's order, the power wheelchair supplier determines the specific power mobility device that is appropriate for the patient and must provide a detailed product description (DPD) to the physician.

The physician must sign and date the DPD and the supplier must receive it prior to delivery of the power wheelchair.

2. Face-to-Face Mobility Examination Details

The face-to-face mobility examination must be conducted by the treating physician prior to writing the order. The power wheelchair supplier must receive the written order within 45 days of this evaluation. 

The face-to-face examination report must address the following:

  • Chief Complaint: The major reason for the office visit was to conduct a Mobility Examination.
  • Physical Assessment as relevant to mobility limitations
  • Patient's mobility limitation and how it interferes with the performance of mobility related activities of daily living (MRADLs) in the home.
  • What MRADLs in the home are impaired by the patient's mobility limitation? (must be specific and have at least (1) MRADL)
  • Why can't a cane or walker meet this patient's mobility needs in the home?
  • Why can't a manual wheelchair meet this patient's mobility needs in the home?
  • Why can't a mobility scooter meet this patient's mobility needs in the home?
  • Does this patient have the physical and mental abilities to operate a power wheelchair safely in the home?
  • Is the patient willing and motivated to use a power wheelchair?

The report shall provide pertinent information about the following elements, but may include other details.1

  • Symptoms & related diagnoses
  • How long the condition has been present
  • History & clinical progression
  • Interventions (including medications) that have been tried and the results
  • Past use of walker, manual wheelchair, power wheelchair or mobility scooter and the results
  • Physical exam & weight
  • Impairment of strength, range of motion, sensation or coordination of arms and legs
  • Presence of abnormal tone, deformity of arms, legs or trunk
  • Neck, trunk, and pelvic posture and flexibility
  • Sitting and standing balance
  • Functional assessment - problems performing the following activities including the need to use a cane, walker or aid of another person:
    • Transferring between a bed or chair and power mobility product
    • Walking to & from bathroom, kitchen, living room, etc.
    • Distance patient is able to walk without stopping; speed, and balance

If you're not sure if you qualify for Medicare coverage, please call us at 1-800-542-7236 and we'll be happy to help you.

 

1 Each element would not have to be addressed in every evaluation.