CMS has implemented a National Coverage Determination for all mobility assistive equipment which includes power wheelchair and power operated vehicles. Listed below is a summary of the questions that must be addressed and charted in your progress notes during your office face-to-face mobility evaluation.
1. What medical condition(s) limit your patient's ability to participate in Mobility Related Activities of Daily Living (MRADLs) in their home?
2. List what MRADLs in the home are IMPAIRED due to your patient's mobility limitation? Some examples are:
- Moving from room to room
- Dressing, Grooming, Toileting, Feeding, Bathing
3. Why can't a cane or walker meet your patient's mobility needs in the home? Some examples are:
- Unsteady gait - history of 3 falls over past month
- Upper Extremity (UE) and Lower Extremity (LE) strength of 2/5
- Desaturates to 87%
- Poor balance
4. Why can't a manual wheelchair meet your patient's mobility needs in the home? Some expamples are:
- UE strength of 1/5
- Right sided weakness of 1/5 due to CVA
- Decreased ROM of shoulder & joints
- Grip strength of 2/5
- Contractures of the hands
- Pain level - 8/10 in shoulder and hands
5. Why can't a scooter (POV) meet your patient's mobility needs in the home? Some examples are:
- Cannot safely transfer in/out of POV
- Home environment does not provide adequate access for maneuvering POV
- Cannot operate tiller of POV
- Lacks postural stability
- UE strength of 1/5
6. Does the patient have the physical and mental abilities to operate a power wheelchair safely in the home?
7. Is the patient willing and motivated to use a power wheelchair?