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Medicare's 5 Year Power Chair Replacement Rule

March 12, 2013

Question: Does Medicare cover replacement power wheelchairs?

Answer: Currently, Medicare may cover a replacement power chair for eligible beneficiaries but only after five years of continuous use.1

cooking at stove in a Hoveround Power ChiarA five-year replacement policy for power wheelchairs ensures that disabled individuals with long term mobility assistance needs will retain the ability to safely get around their home and accomplish essential routines of everyday life.

Some of the key points for understanding Medicare’s power wheelchair replacement benefit are offered below. Additional information may be found at Medicare.gov.

Replacement Policy for Medicare Power Wheelchairs

  • Medicare may cover a replacement power chair after it has reached its reasonable useful lifetime.2
  • Reasonable useful lifetime (RUL) is estimated at, but no fewer than, five years. RUL begins on the date the recipient accepts the power wheelchair delivery.
  • After consistently operating the power chair for 5 years, the recipient may request a replacement.
  • In cases where the chair has sustained irreparable wear, Medicare considers the RUL of the equipment in its decision.
  • Medicare defines irreparable wear as deterioration resulting from day-to-day usage that is unrelated to any specific event or incident.
  • Medicare treats the request for a power wheelchair replacement as a new order. This means a face-to-face examination and detailed documentation of medical necessity must accompany the physician’s order for the power wheelchair.

In cases when there is a change in the patient’s medical condition that requires a different configuration or power chair, Medicare may cover a replacement chair in sooner than 5 years.1

Contact Hoveround at 1-800-542-7236 for more answers about Medicare eligibility and power wheelchair coverage. Mobility Specialists will gladly assist you with getting the mobility solutions you need.

Sources:
Medicare Benefit Policy Manual (Ch.15, Sec. 110.2 Repairs, Maintenance, Replacement and Delivery; 2/18/05)
Power Mobility Devices Coverage Requirements - Ctrs for Medicare & Medicaid Svcs (downloadable PDF)

1Equipment replacement may be necessitated by other factors. Replacement coverage for durable medical equipment, including power wheelchairs, is subject to review by Medicare, relative to case-by-case determinations and compliance with regulatory criteria. Contact 1-800-Medicare or visit www.medicare.gov to learn more.
2 Insurance coverage depends on medical necessity as determined by insurer. Valid doctor’s prescription is required.

This article is for informational purposes only and is not intended as a substitute for professional medical or legal advice.

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