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Medicare Coverage & Electric Wheelchairs
Medicare coverage guidelines
require that the following criteria must be met in order for your electric wheelchair or electric scooter to be covered by Medicare.
1. Physician's Order
For a power wheelchair or mobility scooter to be covered, the electric wheelchair or electric scooter supplier must receive from the treating physician a written order containing all of the following elements:
- 1) Patient 's name
- 2) Description of the item that is ordered - e.g., “electric wheel chair” or “electric scooter”
- 3) Date of the face-to-face mobility examination
- 4) Pertinent diagnoses/conditions that relate to the need for an electric wheelchair or electric scooter
- 5) Length of need for an electric wheelchair or electric scooter
- 6) Physician's signature
- 7) Date of physician signature
This order must be received by the electric wheelchair or electric scooter supplier within 45 days after completion of the physician's face-to-face examination and prior to delivery of the electric wheelchair or electric scooter.
Once the supplier has determined the specific power mobility device that is appropriate for the patient based on the physician's order, the supplier must prepare a written document (called a detailed product description) that lists the specific base (HCPCS code and either a narrative description of the motorized wheel chair or scooter item or the manufacturer name/model) and all options and accessories that will be separately billed. The physician must sign and date this detailed product description and the supplier must receive it prior to delivery of the electric wheelchair or electric scooter.
2. Face-to-Face Examination Details
For a power chair or electric scooter to be covered, the treating physician must conduct a face-to-face examination of the patient before writing the order and the supplier must receive a written report of this examination within 45 days after completion of the face-to-face examination and prior to delivery of the device.
The report of the face-to-face examination shall provide information relating to the following questions:
- What is this patient's mobility limitation and how does it interfere with the performance of activities of daily living?
- 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?
- If an electric wheel chair is provided, why can't an electric scooter meet this patient's mobility needs in the home?
- Does this patient have the physical and mental abilities to operate an electric wheelchair or electric scooter safely in the home?
- Is the patient willing and motivated to use an electric wheelchair or electric scooter?
The report shall provide pertinent information about the following elements, but may include other details. Each element would not have to be addressed in every evaluation.
- Symptoms
- Related diagnoses
- History
- How long the condition has been present
- Clinical progression
- Interventions (including medications) that have been tried and the results
- Past use of walker, manual wheelchair, electric wheelchair, electric scooter and the results
- Physical exam
- Weight
- Impairment of strength, range of motion, sensation or coordination of arms and legs
- Presence of abnormal tone or deformity of arms, legs or trunk
- Neck, trunk, and pelvic posture and flexibility
- Sitting and standing balance
- Functional assessment - any problems with performing the following activities including the need to use a cane, walker or the assistance of another person
- Transferring between a bed, chair, and power mobility product such as an electric wheelchair or electric scooter
- Walking around their home - to bathroom, kitchen, living room, etc. - provide information on distance the patient is able to walk without stopping, speed, and balance
If you're not sure if you qualify for Medicare coverage, please call us toll-free at 1-800-542-7236. We'll be happy to discuss the Medicare guidelines as it relates to electric wheel chairs and electric scooters.
