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Medicare
Guidelines & FAQ'sQ. What is Medicare's coverage criteria for motorized or power wheelchairs?
A. Medicare does rent and will pay for a manual wheelchair, Medicare will on occasion, pay for a motorized unit as well. Although it is not guaranteed that you will qualify or be
reimbursed by Medicare, whether you personally lay out the price for one, or are looking for Medicare to purchase one for you, we can give you some guidelines to follow and the basic criteria that must be met in order for Medicare to either reimburse or authorize payment for a motorized unit.
A power wheelchair is covered when all of the following criteria are met:
The patient’ s condition is such that without the use of a wheelchair the patient would otherwise be bed or chair confined. The patient’ s condition is such that a wheelchair is medically necessary and the patient is unable to operate a wheelchair manually. The patient is capable of safely operating the controls for the power wheelchair.
A patient who requires a power wheelchair usually is totally non-ambulatory and has severe weakness of the upper extremities due to a neurological or muscular disease/condition. If the documentation does not support the medical necessity of a power wheelchair but does support the medical necessity of a manual wheelchair, payment isbased on the allowance for the least costly medically appropriate alternative. However, if the power wheelchair has been purchased, and the manual wheelchair on which payment is based is in the capped rental category, the power wheelchair will be denied as not medically necessary. Options that are beneficial primarily in allowing the patient to perform leisure or recreational activities are non-covered.
Q. What is Medicare's coverage of power operated Vehicles (POVs) or scooters?
A. A power operated vehicle (POV) is covered when all of the following criteria are met:
The patient's condition is such that a wheelchair is required for the patient to get
around in the home. The patient is unable to operate a manual wheelchair. The patient is capable of safely operating the controls for the POV. The patient can transfer safely in and out of the POV and has adequate trunk stability to be able to safely ride in the POV.
Most POVs are ordered for patients who are capable of ambulation within the home but
require a power vehicle for movement outside the home. POVs will be denied as not medically necessary in these circumstances. A POV that is beneficial primarily in allowing the patient to perform leisure or recreational activities will be denied as not medically necessary. If a POV is covered, a wheelchair provided at the same time or subsequently will usually be denied as not medically necessary.
Q. Does Medicare cover Wheelchair Lifts and Ramps?
A. Medicare does not reimburse nor authorize the purchase of a lift for a wheelchair or
scooter at this time. Such items are typically not considered a medical necessity because they can also be used by persons without a medical condition. Don't forget, Medicare covers items needed "inside" the residence.