Physician Resources

• How to Prescribe
• The Medicare Process
• Power Wheelchair vs. Scooter
• Literature Request
• CMS Coverage Determination
• CMS Physician's Fee
  for PMD
• Power Mobility Documentation

Essential Links

• About Hoveround
• Our History
• Our Staff
• Why Choose Hoveround Electric Wheelchairs?
• Power Wheelchair Checklist
• Testimonials
• Literature Request

Prescribing Mobility Products

A physician must prescribe an electric wheel chair (such as the MPV 5®) or electric scooter (such as the Transporter™ GL) in order for Medicare to pay for the mobility product. The Center for Medicare and Medicaid Services (CMS) has established an add-on code billing to the face-to-face mobility evaluation that allows you to be paid for compiling and submitting the required documentation.

An electric wheel chair can make it easier for your patients to retain their independence in their home because it lets them do the everyday activities that many take for granted. But, before you can prescribe a power chair for your patient, a medical need must be established. This is where you play a vital role in documenting and providing us with the essential information required by Medicare to determine if that medical need exists. Medicare guidelines require a face-to-face mobility evaluation prior to writing an order for a power mobility device. You also must document in the chart notes that the mobility evaluation is the main purpose of the office visit.

• 1. Does the beneficiary have a mobility limitation that significantly impairs his/her ability to participate in one or more MRADLs (Mobility-Related Activities of Daily Living) in the home? A mobility limitation is one that:
  
  
  • Prevents the beneficiary from accomplishing the MRADLs entirely; or
  • Places the beneficiary at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to participate in MRADLs; or
  • Prevents the beneficiary from completing the MRADLs within a reasonable time frame.
• 2. Are there other conditions that limit the beneficiary's ability to participate in MRADLs at home?
  
  
  • Some examples are significant impairment of cognition or judgment and/or vision.
  • For these beneficiaries, the provision of MAE (Mobility Assistive Equipment) might not enable them to participate in MRADLs if the comorbidity prevents effective use of the wheelchair or reasonable completion of the tasks even with MAE.
• 3. If these other limitations exist, can they be ameliorated or compensated sufficiently such that the additional provision of MAE will be reasonably expected to significantly improve the beneficiary's ability to perform or obtain assistance to participate in MRADLs in the home?
  
  
  • A caregiver, for example a family member, may be compensatory, if consistently available in the beneficiary's home and willing and able to safely operate and transfer the beneficiary to and from the wheelchair and to transport the beneficiary using the wheelchair. The caregiver's need to use a wheelchair to assist the beneficiary in the MRADLs is to be considered in this determination.
  • If the amelioration or compensation requires the beneficiary's compliance with treatment, for example medications or therapy, substantive non-compliance, whether willing or involuntary, can be grounds for denial of wheelchair coverage if it results in the beneficiary continuing to have a significant limitation. It may be determined that partial compliance results in adequate amelioration or compensation for the appropriate use of MAE.
• 4. Does the beneficiary or caregiver demonstrate the capability and the willingness to consistently operate the MAE safely?
  
  
  • Safety considerations include personal risk to the beneficiary as well as risk to others.
  • The determination of safety may need to occur several times during the process as the consideration focuses on a specific device.
  • A history of unsafe behavior in other venues may be considered.
• 5. Can the functional mobility deficit be sufficiently resolved by the prescription of a cane or walker?
  
  
  • The cane or walker should be appropriately fitted to the beneficiary for this evaluation.
  • Assess the beneficiary's ability to safely use a cane or walker.
• 6. Does the beneficiary's typical environment support the use of electric wheelchairs or electric scooters?
  
  
  • Determine whether the beneficiary's environment will support the use of these types of MAE.
  • Keep in mind such factors as the home's physical layout, surfaces, and obstacles, which may render MAE unusable in the beneficiary's home.
• 7. Does the beneficiary have sufficient upper extremity function to propel a manual wheelchair in the home to participate in MRADLs during a typical day?
  
  
  • The manual wheelchair should be optimally configured (seating options, wheelbase, device weight, and other appropriate accessories) for this determination. Limitations of strength, endurance, range of motion, coordination, and absence or deformity in one or both upper extremities are relevant. Related Change Request #: 3791 MLN Matters Number: MM3791 Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. Page 5 of 7
  • A beneficiary with sufficient upper extremity function may qualify for a manual wheelchair. The appropriate type of manual wheelchair, i.e. lightweight, etc., should be determined based on the beneficiary's physical characteristics and anticipated intensity of use.
  • The beneficiary's home should provide adequate access, maneuvering space, and surfaces for the operation of a manual wheelchair.
  • Assess the beneficiary's ability to safely use a manual wheelchair. Note: If the beneficiary is unable to self-propel a manual wheelchair, and if there is a caregiver who is available, willing, and able to provide assistance, a manual wheelchair may be appropriate.
• 8. Does the beneficiary have sufficient strength and postural stability to operate a POV/ electric scooter?
  
  
  
  • A POV is a 3- or 4-wheeled device with tiller steering and limited seat modification capabilities. The beneficiary must be able to maintain stability and position for adequate operation.
  • The beneficiary's home should provide adequate access, maneuvering space, and surfaces for the operation of a POV
  • Assess the beneficiary's ability to safely use a POV/electric scooter.
• 9. Are the additional features provided by a power wheelchair needed to allow the beneficiary to participate in one or more MRADLs?
  
  
  • The pertinent features of a power chair compared to a POV are typically control by a joystick or alternative input device, lower seat height for slide transfers, and the ability to accommodate a variety of seating needs.
  • The type of wheelchair and options provided should be appropriate for the degree of the beneficiary's functional impairments.
  • The beneficiary's home should provide adequate access, maneuvering space, and surfaces for the operation of an electric wheelchair.
  • Assess the beneficiary's ability to safely use a power wheelchair. Note: If the beneficiary is unable to use an electric wheelchair, and if there is a caregiver who is available, willing, and able to provide assistance, a manual wheelchair is appropriate. A caregiver's inability to operate a manual wheelchair can be considered in covering a power wheelchair so that the caregiver can assist the beneficiary.

Once you've determined from the face-to-face mobility evaluation that your patient's mobility needs would best be served with an electric wheelchair, you'll need to provide the following documentation within 45 days of your face-to-face mobility evaluation:

• Prescription for an electric wheelchair
• Chart notes that detail the patient's mobility need
• Written summary of face-to-face evaluation

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 (termed a detailed product description) that lists the specific base (HCPCS code and either a narrative description of the 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 wheel chair or electric scooter.

The written prescription must include:

• Beneficiary's (patient's) name
• Detailed description of item that is ordered
• Date of the face-to-face examination
• Pertinent diagnosis/conditions that relate to the need for a power wheelchair
• Length of time the patient will need the device
• Physician's signature
• Date of physician's signature

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 wheel chair or electric scooter safely in the home?
• Is the patient willing and motivated to use an electric wheel chair 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 scooter, electric wheel chair 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 PMD
• 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

The elements that are addressed will depend on the diagnoses that are responsible for the mobility deficit.   For example, for patients with COPD, heart failure or arthritis, the major emphasis will be on symptoms and history of the progression of their condition rather than on the physical examination.   Functional assessment is important for all patients.

Physicians shall also provide reports of pertinent laboratory tests, x-rays, and/or other diagnostic tests (e.g., pulmonary function tests, cardiac stress test, electromyogram, etc.) performed in the course of management of the patient.

Although patients who qualify for coverage of a power chair may use that device outside the home, because Medicare's coverage of a wheelchair is determined solely by the patient's mobility needs within the home, the examination must clearly distinguish the patient's abilities and needs within the home from any additional needs for use outside the home.

Physicians shall document the evaluation in a detailed narrative note in their charts in the format that they use for other entries. The note must clearly indicate that a major reason for the visit was a mobility evaluation.