How will I know if a power wheelchair is covered by Medicare?

How will I know if a power wheelchair is covered by Medicare?

If you are in need of a powered mobility device, Medicare may assist in the purchase of it if you have certain limited mobility issues. These issues must negatively affect your ability to perform one or more mobility related activities you participate in on a regular basis. These MRADLs will include activities such as: cooking, cleaning, bathing, dressing, grooming and other common activities performed within the home.  Therefore, you must understand that Medicare will not pay for a powered mobility device if it is intended for outside use. Medicare will not approve coverage of a power wheelchair if it is only used for the following:

  • Outside,
  • Shopping centers,
  • Grocery stores,
  • Strolls down the street or to the neighbors home,
  • Any other outside activities that require walking longer than you can possibly walk,
  • If the activity is not considered medically necessary.

All of these above activities will not meet Medicare’s standards/terms for covering a power wheelchair. Below we have included the terms required for Medicare to cover a power wheel chair. Medicare will approve coverage of a power wheelchair if the following apply:

  • Individual mobility is grossly impaired and affects ability to participate in one of more of the MRADLs (mobility related activities of daily living).
  • The limits of mobility cannot/will not see drastic improvement even while using a cane or walker.
  • A manual wheelchair is not adequate for medical improvement due to weakness in a patient’s arms, pain or additional handicaps/dysfunctions.
  • Patient can safely transfer on and off the power wheelchair; maintain posture, stability and position.
  • Patient is mentally capable of operating the equipment safely in the home.
  • Patient is physically capable of operating the equipment safely in the home.
  • Patient’s home support use of the power wheelchair with adequate space.

This information must be supported with physical documentation from a doctor and provided in the form of F2F (face-to-face) notes. During this F2F visit, your doctor will perform an actual mobility evaluation, which will review your history of mobility issues and include a physical exam to determine your current mobility level. If additional information is needed (usually by the insurance), you may be required to see a physical therapist or occupational therapist in addition to your primary care physician. Our trained mobility staff of professional can walk you through the process of receiving a power wheelchair. Contact us today @ 888-345-1780 or complete the form online.

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