Medicare Physician Resource Guide

Coverage Criteria and Documentation Requirements for Power Mobility Devices

(Power Wheelchairs and Scooters)

National Coverage Determination (NCD) for Power Mobility Devices (PMD)

Medicare has changed the coverage criteria and documentation requirements for Power Mobility Devices for dates of service (date of delivery) on or after May 5, 2005.  Power Mobility Devices include power wheelchairs and scooters/power operated vehicles (POV).  If you are considering prescribing a Power Mobility Device please review the following information as it will assist you in understanding how these changes have affected the prescription and funding process with Medicare. A Certification of Medical Necessity (CMN) form is no longer required.

Medicate has modernized the policy and replaced the "Bed or Chair Confined" requirement with consideration now given to the beneficiary's ability to safely and in a reasonable time frame participate in one or more Mobility Related Activities of Daily Living (MRADLs).

MRADLs: Dressing, grooming, toileting, bathing and eating (including Assisted Living Facilities) in customary locations within the home.

A face-to-face examination of your patient is required prior to prescribing a PMD.

As a prescribing physician of a PMD you are entitled to a new add-on payment for conducting the face-to-face examination and for the preparing and sending the required documentation to us at Florida Mobility Products. The new add-on code is G0372 and will be paid at a rate equal to the physician fee schedule relative values established for a level 1 office visit for an established patient (CPT Code 99211).

Coverage Criteria

A face-to-face examination of your patient is required prior to prescribing a PMD.

The 9 questions listed below are the method for examination and should be used to determine the appropriate Mobility Assistive Equipment (cane, walker, manual wheelchair, POV/scooter and power wheelchair).  This information must be located in the patient's medical record that includes your progress notes, hospital notes, home health records and/or through the face-to-face examination of the patient.

1.    Does the beneficiary have a limitation that significantly impairs his/her ability to participate in one or more MRALDs in  the home?  If so, document your patient's limitation(s) that prevent his/her ability to be safely mobile in his/her home.

2.    Are there any other conditions that limit the beneficiary's ability to participate in MRALDs at home (for example, any cognitive impairment)?  If the reason is not due to a cognitive impairment proceed to question 4.

3.    If these other limitations exist, is there a way to compensate for this limitation?  If so, document how the limitation can be compensated for - such as an around the clock caregiver, medication, or therapy.  If the limitation (question 2) cannot be compensated for through ant other means, please note this in the patient's file.

4.     Does the beneficiary or caregiver demonstrate the capability and willingness to consistently operate a Power Mobility Device safely?

5.    Can the functional mobility deficit be resolved with a cane or walker?  Can your patient safely and within a reasonable time frame use a cane or walker to participate in MRALDs?  If not, please document the reason why and the results of cane and walker trials (if applicable).

6.    Does the beneficiary's living environment support the use of wheelchairs including scooters/Power operated vehicles (POVs)?  The PMD supplier will perform a home assessment to determine that the beneficiary's living environment is sutable for a PMD.  A copy of this home assessment will be kept in the PMD supplier patient's file.

7.    Can the patient's mobility limitation be resolved with a manual wheelchair?  Please consider the patient's upper extremity function.  Does the patient have the strength, range of motion (ROM) and endurance to safely propel a manual wheelchair all day, every day (and in a reasonable time frame) to participate in MRADLs?

8.    Can the patient's mobility limitation be resolved with a POV/scooter?  Please consider the following if prescribing a scooter - the patient's trunk stability and upper extremity function (see above) to safely operate the scooter's tiller an a daily basis to participate in MRADLs, the need for safe transfers, positioning and pressure relief, dexterity in his/her hands to operate the scooter controls.  Also, the PMD supplier will determine through a home assessment what is the appropriate PMD (i.e. scooter/POV or power wheelchair) for the patient to use in his/her home.

9.    Does the patient require the additional features provided by a power wheelchair to safely participate in MRADLs within a reasonable time frame in his/her home?

Documentation Requirements

Medicare requires the above information be supported by the patient's medical record.  The medical record includes your progress notes, chart notes, hospital records, home health records and/or through a physical/occupational wheelchair evaluation.  Once you complete the face-to-face examination with your patient and have determined that a PMD is appropriate you may write a prescription for a PMD.

If this power wheelchair is being prescribed for regular use this must be noted in the patient's chart.

The patient's medical record must support the prescription for the device ordered.

Useful life of the PMD - The "useful life" of Durable Medical Equipment (PMDs are in this category) is considered no less than 5 years beginning with the date of delivery.  If you prescribe a PMD please consider the patient's usage and his/her prognosis for at least the next 5 years.  Considerations include the patient's condition (foreseen changes in his/her medical condition - i.e., a progressive condition such as MS) and the patient's current weight along with history of weight gain and predicted weight gain (if applicable).

POINTERS FOR PHYSICIANS AND OTHER TREATING PRACTITIONERS:

When prescribing a power wheelchair or power scooter the physician or other treating practitioner must provide the supplier with documentation of the medical necessity of the device prescribed. This should include pertinent parts from the documentation of the beneficiary’s face-to-face evaluation, such as the history, physical examination, diagnostic tests, summary of findings, diagnoses, and treatment plans. The physician or treating practitioner should select only those parts of the medical record that clearly demonstrate medically necessity for the PMD. The parts of the medical record selected should be sufficient to: delineate the history of events that led to the request for the PMD; identify the mobility deficits to be corrected by the PMD; establish that other treatments do not obviate the need for the PMD, establish that the beneficiary lives in an environment that supports the use of the PMD: and establish that the beneficiary or caregiver is capable of operating the PMD. In most cases, the information recorded at the face-to-face examination will be sufficient. However, there may be some cases where the physician or treating practitioner has treated a patient for an extended period of time and the information recorded at the face-to-face examination refers to previous notes in the medical record. In this instance, those previous notes would also be needed. The physician, treating practitioner or supplier that is a HIPAA covered entity should make sure to remove or edit any materials that may be contained within the medical record that are not necessary to support the prescription.  

Prescription Requirements

New CMN/Rx Replacement Form Click to download

  All Power Mobility Devices require a written prescription prior to delivery. The equipment supplier is required by Medicare to have the written prescription, plus proof you have considered the 9 questions listed above, in their files prior to delivering the Power Mobility Device.

The written prescription must contain the following:

1.    Beneficiary's name

2.    Description of item that is ordered.  This may be general - e.g., "power wheelchair" or may be more detailed.

3.    Date of face-to-face examination

4.    Written pertinent diagnosis/conditions that relate to the need for the Power Mobility Device

5.    ICD-9 Codes for the pertinent diagnosis/conditions that relate to the need for the Power Mobility Device

6.    Length of need (99 months = forever)

7.    Physician's signature

8.    Physician's UPIN #

9.    Date of  Physician's signature

10.  Physician's address and phone #

Please forward the detailed written prescription, along with supporting documentation to the 9 questions, to Florida Mobility Products as soon as possible to ensure that your patient receives the prescribed equipment in a timely manner. Medicare requires Florida Mobility Products receive the written prescription and supporting documentation for the Power Mobility Device and make delivery within 60 days from the date of the face-to-face examination.  A timely response will allow us to gather any specialized items required and avoid your having to re-evaluate the patient (See following exemption).

If all questions are not supported by the medical record history and cannot be addressed through a face-to-face examination of the patient you may prescribe a physical/occupational therapist wheelchair evaluation to address or support the remaining questions.  (In the event you refer your patient to a PT/OT for a wheelchair evaluation, you must obtain a copy of the written evaluation from the therapist and indicate concurrence or disagreement with the assessment.  Please co-sign the assessment and submit a copy of the assessment with your written prescription to Florida Mobility Products within 30 days of the date of your PMD prescription.

If you need more clarification or information just give us a call.

Florida Mobility & Medical Products
8451 S John Young Parkway
Orlando, FL 32819
407-363-3535

V.A. Repair Center
"Florida's REAL Scooter Store"

Mon-Fri: 9:00am - 6:00pm
Sat: 10:00am - 4:00pm

Fax: (407) 363-4475
Toll Free: 1-866-363-3535