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Power Mobility Device Prior Authorization Demonstration Project

Starting September 1, 2012, the Medicare Fee-For-Service Program will conduct a three-year prior authorization demonstration project for power mobility device claims within seven states. Mobility equipment suppliers must submit medical necessity documentation to Medicare and wait for a prior authorization review before fulfilling prescriptions for certain types of power wheelchairs and  mobility scooters.

Beneficiaries permanently living in CA, IL, MI, NY, NC, FL, TX,MD, NJ, PA, IN, KY, OH, GA, TN, LA, MO, WA, and AZ, must have their power wheelchair documentation submitted to and reviewed by a Durable Medical Equipment Medicare Administrative Contractor (DME MAC). Within 10 business days, the DME MAC will mail a decision letter to the beneficiary, physician and equipment supplier (Hoveround) either to approve or deny the prior authorization request.

To help assist you and your physician adhere to the Medicare documentation requirement, please print out this mobility examination packet. Take it along with you to your face-to-face mobility examination appointment and give it to your physician. [download here]

If a DME MAC determines your medical documentation is insufficient, or lacks even one data element from the face-to-face examination and progress notes, Medicare might not approve your power wheelchair prior authorization request. Although you’ll have the option to re-submit your prior authorization request, specific guidelines might require that you visit your physician again and obtain new documentation.

This could increase the amount of time it will take for you to get your power chair.   

Detailed information about Medicare’s prior authorization process for power mobility assistance is available from the Centers for Medicare & Medicaid Services. Call toll free, 1-800-MEDICARE, or visit www.medicare.gov.