In 2008, Medicare increased the difficulty of the requirements necessary to obtain a power wheelchair. This was done because of the amount of false claims submitted by providers and individuals, such as the popular “Scooter Store.” In order to obtain a power wheelchair you must now provide the following documentation to support your claim:
- It must be for in-home use only.
- Your doctor must provide a prescription (Rx) stating that it is medically necessary for you to have a scooter or powered wheelchair within your home.
- The prescription must state that you have limited mobility.
You must also meet the following conditions:
- Difficulty moving on a daily basis. Daily activities such as bathing, cooking, dressing, getting in or out of bed or a chair and using the restroom are extremely difficult and a manual wheelchair, cane or crutch does not assist in improving the condition.
- Difficulty lifting yourself up/down. You are unable to safely get on and off a manual wheelchair or scooter independently.
- Medicare network compatibility. The doctor and provider/supplier are both in network with Medicare.
- Completion of physical therapy. If PT is required, you must complete it. The Physical Therapist (P/T) will also determine if the powered mobility device is medically necessary after your evaluation. If not, you will not be approved and insurance will not pay.
As you can see, obtaining a powered mobility device through your insurance will not be an easy task. If you are approved for a power wheelchair, Medicare will normally pay 80% of the cost for you over a 13-month time frame. The remaining 20% (copay) will be your responsibility. For more information concerning power wheelchairs and Medicare guidelines, feel free to contact us for more information. Our expert mobility representatives will be glad to help!