Medicare Criteria for Power Wheelchairs
An individual who requires a power wheelchair is usually totally non-ambulatory and has severe weakness of the upper extremities that prevents them from self-propelling in a manual wheelchair. Medicare has certain coverage criteria in order to qualify a patient for a power wheelchair. A Jazzy power base unit could be considered medically necessary when all of the following coverage criteria are met:
Medical documentation needed:
- A Face-to-Face Mobility Exam must be conducted with the primary physician. A referral to a Physical or Occupational Therapist may be required.
- A prescription from the treating physician.
- Chart Notes from the appointment indicating a mobility evaluation occurred along with chart notes for the past six months related to the medical necessity of DME.
- The patient requires the use of a wheelchair to move around in their residence; and,
- The patient's condition is such that a power wheelchair will be needed long term (at least 6 months)
For additional information on the process of obtaining a power wheelchair please call our insurance billing speciailist at (425) 481-6546 or (800) 376-8267.
