For a wheelchair to be covered by Medicare, a written signed and dated order must be received before a claim is submitted to Medicare.

 

A wheelchair is covered if:

a)      Criteria A, B, C, D, and E are met; and

b)      Criterion F or G is met

 

A)    The patient has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living (MRADL) such as toileting, feeding, dressing, grooming, and bathing in customary locations in the home.

 

-   A mobility limitation is one that:

1)      Prevents the patient from accomplishing a MRADL entirely, or

2)      Places the patient at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform an MRADL; or

3)      Prevents the patient from completing an MRADL within a reasonably time frame

 

B)    The patient’s mobility limitation cannot be sufficiently resolved by the use

of an appropriately fitted cane or walker.

 

                 C) The patient’s home provides adequate access between rooms, maneuvering

                       space, and surfaces for use of the wheelchair.

 

     D) Use of a wheelchair will significantly improve the patient’s ability to

participate in MRADLs and the patient will use it on a regular basis

in the home.

 

E)     The patient has not expressed an unwillingness to use the wheelchair

that is provided in the home.

_________________________________________________________

F)     The patient has sufficient upper extremity function and other physical

and mental capabilities needed to safely self-propel the wheelchair.

-         Limitations of strength, endurance, range of motion, or coordination, presence of pain, or deformity or absence of one or both extremities are relevant to the assessment of function.

 

                G) The patient has a caregiver who is available, willing, and able to provide    

      assistance with the wheelchair.