Medicare Power Wheelchair Coverage Guidelines

Medicare Power Wheelchair Coverage Guidelines

If you have trouble moving around within your home and are unable to use a cane/walker, or a standard manual wheelchair, a power wheelchair may be right for you. A power wheelchair is a motorized version of a standard wheelchair, controlled via the use of a joystick mounted on the armrest. Our power wheelchairs are fully adjustable and come in varieties that can accommodate any size and shape. They are easily maneuverable in tight spaces and fit well in almost any home. Those with mobility issues, such as arthritis and back pain, as well as those with respiratory issues such as COPD are all good candidates for power wheelchairs.

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.”

Medicare Guidelines for Power Wheelchair

Medicare Part B (Medical Insurance) covers durable medical equipment (DME) like a power wheelchair. You must have a doctor’s prescription for Medicare to cover a power wheelchair.

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.

What Activities Won’t Medicare Cover for a Power Wheelchair?

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

What Activities Will Medicare Cover for a Power Wheelchair?

If your mobility issues negatively affect your ability to perform one or more activities of daily living (ADLs). These will include activities such as: cooking, cleaning, bathing, dressing, grooming and other common activities performed within the home. Medicare will approve coverage of power wheelchair if the following apply:Regain your Independence with a Power Wheelchair

  • Individual mobility is grossly impaired and affects the ability to participate in one or more of the ADLs (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.
  • Safely transfer on and off the power wheelchair; maintain posture, stability, and position.
  • Mentally capable of operating the equipment safely in the home.
  • Physically capable of operating the equipment safely in the home.
  • Patient’s home support use of the power wheelchair with adequate space.

How Much Will Medicare Cover for a Power Wheelchair?

Typically, Medicare covers 80% of your power wheelchair over a 13-month period. You will pay the remaining 20% out of pocket.

The Affordable Care Act requires that a physician (MD, DO or DPM), physician assistant (PA), nurse practitioner, (NP) or clinical nurse specialist (CNS) has had a face-to-face examination with the beneficiary within six months of the written order for and delivery of power mobility devices supplied by a DME.

The patient will come in and see the physician for an exam. At the mobility evaluation, the doctor must take measurements of pain and strength associated with your illnesses to prove this. Additionally, it must be recorded how far a patient is able to walk without assistance. The physician will, only after seeing the patient, write the order for the device.

medicare-power-wheelchairIf you have not used a cane, walker, or manual wheelchair, it is suggested that you attempt using them prior to a power chair. A cane, walker, and manual wheelchair all must be ruled out by a doctor as insufficient for the patient to complete their activities of daily living inside the home.

If manual devices do not meet a patient’s daily needs, they most likely meet Medicare requirements to receive a power wheelchair or scooter.

Though patients may meet these qualifications, some physicians will refer them to alternative solutions like physical therapy. This can also lead to acquiring a power mobility device if the therapy does not offer positive results, and will establish more extensive documentation of things like range of motion, torso stability, and extremity strength. A power mobility device is a last resort, and many physicians will prescribe other therapies and devices to prevent dependency on a power mobility device.

How Aeroflow Helps

Here at Aeroflow, we would be happy to assist you with getting your power wheelchair through Medicare. To begin the process, a Mobility Specialist will help get you to schedule your mobility assessment for your power wheelchair through insurance. We will make sure your doctor has a complete list of Medicare requirements that need to be documented on the day of your mobility assessment. We will also provide you with information and constant updates regarding the progress of your power wheelchair.

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