Medicare Requirements for Power Wheelchairs & Scooters

In October of 2005, Medicare began requiring any patient seeking an electric wheelchair or mobility scooter to have a face-to-face exam with a physician. This exam serves as an evaluation to ensure that the patient meets all of Medicare’s requirements for power mobility including electric wheelchairs and scooters. Most of the time, the patient has already met with a medical equipment supply company who will send over paperwork to the physician to be completed during the exam.

The paperwork will normally consist of some sort of mobility assessment evaluation form, a request for a detailed prescription from the physician and any other supporting documentation, which may include copies of the patient’s chart notes or a letter of medical necessity (LOMN). Since Medicare does not offer a standard set of electric wheelchair evaluation forms, paperwork may vary by medical equipment supply company.

During the face-to-face exam for powered mobility, the physician will address the following nine required items with the patient to determine eligibility for an electric wheelchair and document his or her answers on the paperwork provided or into the patient’s chart notes:

1. Does the patient have a limitation that significantly impairs his or her ability to participate in one or more mobility related activities of daily living (MRADLs) in the home?
2. Are there other conditions that limit the patient’s ability to participate in MRADLs at home?
3. Is there another way to compensate for the patient’s limitation in the home? For example, could a caregiver assist the patient or could some sort of therapy work instead of the need for an electric wheelchair?
4. Is the patient capable and willing to operate an electric wheelchair safely?
5. Can a cane or walker be used instead of an electric wheelchair? If not, why?
6. Does the patient’s home support the use of an electric wheelchair?
7. Can the patient’s mobility limitation be resolved with a manual wheelchair? If not, why?
8. Can the patient’s mobility limitation be resolved with a mobility scooter (three wheel style)?
9. Does the patient need the additional features of an electric wheelchair to safely conduct his or her daily living activities?

Some physicians will complete the paperwork during the exam while others will make notes and complete the paperwork at some point after the appointment is over. Medicare allows 45 days after the completion of the exam for the paperwork, prescription and any supporting documentation to be completed and returned to the medical equipment company. If a physician does not get the paperwork completed during this 45-day window, the patient will be required to schedule an additional exam to be evaluated again and the 45-day time limit will start over.

One Response to Medicare Requirements for Power Wheelchairs & Scooters

  • ROY SLEZAK says:

    I HAVE 2 HIP REPLACEMENT, BACK SURGERY, ONE EYE, AND AM 85 YEARS OLD. HOW EVER THESE THINGS ARE NOT A PROBLEM FOR EVERYONE. I LIVE IN ARIZONA WHERE MOST YARDS ARE ROCK AND I LOVE WORKING IN THE YARD HOWEVER MOST SCOOTERS JUST GET MIRED DOWN IN THE ROCK BECAUSE OF THE TIRE SIZE. I WAS APPROVED FOR A
    PRIDE “V[CTORY” BUT ALL IT DO WAS SPIN THE WHEELS IN THE ROCK. iS THERE ANYTHING ELSE MEDICARE WOULD PROVIDE THAT WOULD FIT MY PROBLEM? I HATE TO GIVE UP MY YARD

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