Medicare Power Wheelchair Coverage Guidelines

Medicare coverage guidelines require that the following criteria must be met in order for your new power wheelchair to be covered by Medicare.

1. Physician’s Order

For a power wheelchair to be covered under Medicare, the wheelchair 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. “power wheelchair”
• 3) Date of the face-to-face mobility examination
• 4) Pertinent diagnoses/conditions that relate to the need for a power wheelchair
• 5) Length of need for a power wheelchair
• 6) Physician’s signature
• 7) Date of physician 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.

Once the supplier has determined the specific power mobility device that is appropriate for the patient based on the physician’s order, the wheelchair 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 wheelchair 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 wheelchair supplier must receive it prior to delivery of the power wheelchair.

2. Face-to-Face Examination Details

For a power wheelchair to be covered under Medicare, 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 mobility device. Medicare requires that the dates and timing of this process be followed to the letter, and Hoveround ensures that this process is followed for each and every case.

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 a power wheelchair is provided, why can’t an electric 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. 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, 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 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 a power wheelchair.
• 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 power wheelchairs.