Patient Resources

A Medicare patient seeking a custom manual wheelchair must meet all of the following coverage criteria to satisfy medical necessity requirements:

• Patient has mobility limitations impairing their participation in Mobility Related Activities of Daily Living (MRADL), e.g. dressing, grooming, toileting, feeding, or bathing, in customary locations of their home that meet one of the following:
  • Prevents them from accomplishing an MRADL entirely.
  • Places them at heightened risk of morbidity or mortality secondary to trying to do an MRADL.
  • Prevents them from completing an MRADL within a reasonable time frame.
• Using a properly fitted cane or walker doesn’t resolve the patient’s mobility limitations.
• Patient’s home allows adequate access between rooms, maneuvering space, and surfaces for using the specific manual wheelchair.
• Using a manual wheelchair will significantly improve the patient’s ability to take part in MRADLs and they will use it regularly in the home.
• Patient hasn’t expressed an unwillingness to use a manual wheelchair in their home.
• Patient has enough upper extremity strength and other physical and mental abilities to safely self-propel the manual wheelchair in their home during a typical day.
• Patient’s caregiver is available, willing, and able to help with the wheelchair.

Please call your physician’s office and request a face-to-face mobility evaluation if you qualify.

A Medicare patient seeking a Power Mobility Device (PMD), which includes a Power Wheelchair (PWC), must meet all of the following coverage criteria to satisfy medical necessity requirements: 

• Patient has a mobility limitation that significantly impairs their ability to participate in one or more Mobility Related Activities of Daily Living (MRADL), e.g. dressing, grooming, toileting, feeding, or bathing, in customary locations of their home.
• Their mobility limitation cannot be sufficiently and safely resolved by using an appropriately fitted cane or walker.
• They do not have sufficient upper extremity function to self-propel an optimally configured manual wheelchair in their home to perform MRADLs during a typical day.

For Power Wheelchairs (PWC), the patient meets all the general coverage criteria for PMDs stated above as well as the following:

• Patient does not meet the coverage criteria for a Power Operated Vehicle (POV), e.g. scooter. 
• Patient has the mental and physical capabilities to safely operate the PWC, or if the patient is unable to safely operate the PWC, has a caregiver who is available, willing, and able to safely operate the PWC.
• Patient’s weight is less than or equal to the weight capacity of the PWC and greater than or equal to 95 percent of the weight capacity of the next lower weight class of PWC.
• Patient’s home provides adequate access between rooms, maneuvering space, and surfaces for operating the PWC.
• Using a PWC will significantly improve patient’s ability to participate in MRADLs, and the patient will use the PWC in their home.
• Patient has not expressed an unwillingness to use a PWC in their home.

Please call your physician’s office and request a face-to-face mobility evaluation if you qualify.