Medicare Requirements for Scooters and Powerchairs

Speeding senior on motorized scooter
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People who have become disabled and can no longer walk or cannot walk without difficulty may be interested in getting a mobility scooter or powerchair. It seems simple enough – your doctor will fill out paperwork that will enable you to receive a scooter or powerchair at little or no cost. Many disabled individuals and their caregivers find out that the process can be much more difficult than that.

It can require several trips to a physician or specialist and navigating red tape with the government through the Medicare system. For some, the process may seem hardly worth the effort.

Knowing what to expect can help with the personal decision of whether to use a manual wheelchair or to forge ahead with the application for a scooter or powerchair, also referred to as power mobility devices or PMDs.

Medicare Requirements

A PMD is covered by Medicare “only if the beneficiary has a mobility limitation that significantly impairs his/her ability to perform activities of daily living within the home. If the PMD is needed in the home, the beneficiary may also use it outside the home.”

Physician Requirements

Physicians bear the burden of prescribing a mobility scooter or powerchair to disabled individuals who need them in order to perform necessary and daily activities inside their home. These motorized vehicles can make a big difference in their mobility, especially if they have little or no upper body strength.

The PMDs primarily must be used within the home, so they must fit through all of the doorways and entrances to the home.

The specific physician requirements by the Centers for Medicare & Medicaid Services are as follows:

  • A face-to-face meeting with the patient to determine the medical necessity of a PMD.
  • A copy of the examination records, as well as a copy of the prescription for the device, will be sent to the supplier.
  • Additional medical documentation, if necessary, to support the request for a PMD will be provided to the supplier.
  • All documentation must be received by the PMD supplier within 30 days of the face-to-face examination.
  • Bill an appropriate Evaluation and Management (E&M) code for the face-to-face examination.
  • Use the appropriate code to bill for the additional time required to provide the examination and documentation to the supplier of the PMD.

Determination of Patient’s Needs

Patients will need to answer specific questions in their face-to-face interview with a physician. Specifically, they or their caregivers will have to answer or be able to demonstrate the following:

  • What is their mobility issue, and how does it interfere with their daily activities?
  • Why can’t a cane or walker be used for their mobility needs?
  • Why can’t a manual wheelchair be used to meet their mobility needs?
  • Is the individual capable of transferring to and from the PMD and operating it safely within their home?
  • Why can’t a PMD be used to meet an individual’s need in the home?
  • Does the individual have the physical and mental capacity to operate the PMD by themselves?

    Out of Pocket Purchase

    Not everyone will qualify for a mobility scooter or powerchair. Some individuals may feel that they need them, but unfortunately, their physician, or a claim processor, doesn’t think that they meet the requirements as defined by Medicare.

    There is no restriction on buying a mobility scooter or powerchair from a supplier if you want to purchase it out of pocket with no insurance. There are numerous suppliers both nationally and locally (usually nearby to hospitals and nursing homes) that will sell PMDs to anyone. It is also important to note that there are a number of retailers that sell used or reconditioned models at greatly reduced prices.

    The used models may be sold as-is, or with a limited warranty. Used PMD models may also be found in a newspaper’s 'for sale' ads, as well as other similar local ads online.

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