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Medicare Coverage for Power Mobility: Understanding The Face-to-Face Mobility Examination

July 18, 2011

The Face-to-face-mobility-examinationOne of the most important requirements for getting a Medicare power wheelchair is a properly documented face-to-face mobility examination. This article will help clarify exactly what's involved.

Some who might benefit from a Medicare power wheelchair avoid pursuing the option because they mistakenly believe the process is too complicated. This lack of understanding about  how to obtain a power chair through Medicare can result in lost opportunities for renewed mobility.

Beneficiaries should know that getting a power wheelchair might be easier than they think. Knowing and following the rules for Medicare power mobility coverage might even help to increase the chances for approval1.

A good place to begin is with the mobility examination.

The Face-to-Face Mobility Examination

PhysiciansA face-to-face mobility examination, sometimes referred to as an in-office mobility evaluation, is a required doctor's office visit. It is mandated by Medicare and must occur prior to receiving a power wheelchair prescription.

Patient mobility must be the primary focus of the examination. Any and all difficulties the patient has experienced with performing mobility-related activities of daily living (MRADLs) inside the home need to be discussed and documented. 

The patient will also undergo a physical exam to further establish the medical necessity for power mobility. Doctor records must clearly show that:

a.   The patient cannot safely or effectively use other assistive aids, such as a cane, walker, manual wheelchair, or scooter
b.   Only a power chair can help resolve the patient's mobility deficits in the home
c.   A power wheelchair has been determined to be medically necessary for the patient to perform MRADLs

Functional Assessments to Expect During the Mobility Evaluation

Patients can anticipate their doctor, or the treating practitioner, to chart the following information2 during the office visit:

  • Patient data and vital signs (age, height, weight, blood pressure readings, etc)
  • Medical history, progression and diagnoses (including neurological and/or musculoskeletal disorders, falling incidents, recurrent extremity pain, medications administered, etc)
  • Mobility assessments and test results (range of motion, strength levels, walking duration, balance, etc)
  • Ambulatory challenges and all physical conditions that directly impair MRADLs

Documenting the Medical Necessity for Power Mobility

ClinicianPrecise paperwork must be submitted to the power wheelchair provider within 45 days of the face-to-face examination. To help assist you and your physician adhere to the Medicare required documentation, print out this mobility examination packet. Take it with you to your face-to-face mobility examination appointment and give it to your physician. [download here]

Beneficiaries can help move along the Medicare claim process by ensuring documentation includes all of the following:

  • Detailed chart notes documenting 'patient mobility' as the focus of the office visit
  • Medical diagnosis and records supporting the necessity of power mobility
  • Medical documentation explaining why other, less expensive mobility equipment will not accommodate the beneficiary's mobility needs within the home environment
  • A prescription for a power wheelchair, signed and dated by the prescribing practitioner

When everyone works together throughout the power wheelchair process, chances improve for all requirements to be fully met.  Medicare beneficiaries, their doctors and the mobility specialists who verify documentation and track the progress of Medicare wheelchair claims, all play a pivotal role in seeing that an electric power chair makes its way to the recipient who truly needs it.

1 This article is for informational purposes only. Its contents present only a general summary of Medicare's face-to-face examination criteria for power mobility under currently existing guidelines. This article does not guarantee claim approval, coverage or reimbursement based on the information contained herein.
2Each element may not necessarily be addressed during every face-to-face examination.

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