The diagnosis that will cover a wheelchair are mobility issues, inability to walk, severe arthritis, illness or injury which causes limited mobility, COPD, Congestive heart failure, amputations, spinal cord injuries, paralysis, multiple sclerosis, muscular dystrophy and cerebral palsy or other conditions that make it difficult for you to walk and get around.
Things that qualifies a patient for a power wheelchair are loss of mobility, or severe enough mobility issues that prevent you from walking and prevent you operating a normal wheelchair.
If you have a mobility limitation where you're unable to walk or have difficulty operating a normal wheelchair or performing daily activities like eating, using the bathroom, dressing and you're not able to simply use a cane or walker to get around then you will likely qualify for a power wheelchair.
You also need to be able to safely operate the power wheelchair either on your own or with help and you need to maintain your balance and position.
Disabilities that qualify you for a power wheelchair are muscular dystrophy, multiple sclerosis, cerebral palsy, spinal cord injuries, paralysis and amputations.
To qualify for a power wheelchair you must meet with your doctor and have a face to face exam and must have a disability severe enough to prevent you from using a normal wheelchair and require the use of the power wheelchair to get around the house.
The length of time that it takes for Medicare to approve a power wheelchair is between a few weeks to a few months.
The process for Medicare to approve a power wheelchair involves several steps which can take some time which include.
A doctors exam, prior authorization, submitting documentation and often a home assessment.
Your doctor must send a prior authorization request to the durable medical equipment Medicare Administrative Contractor and the DME will respond within 10 days.
You also must meet certain requirements and be diagnosed with conditions such as severe arthritis, severe inability to walk, stroke, multiple sclerosis etc.
Medicare will pay for a power wheelchair when it's medically necessary.
For Medicare to pay for a power wheelchair you must meet certain requirements.
The doctor must write a prescription for the power wheelchair after they have a face to face exam and conversation with you.
The doctor will first consider other options like a manual wheelchair, walker or cane.
If you're unable to physically operate a manual wheelchair then you'll likely be approved for the power wheelchair and Medicare will pay for it.
However if you're able to physically operate a manual wheelchair then you may be denied the power wheelchair but be approved for a regular wheelchair or scooter.
Your healthcare provider will also often assess your home to ensure there's enough room for the power wheelchair.
You also must have Medicare Part B for the Power wheelchair and they will only approve the power wheel chair if you need it inside the home.
If you only need the power wheelchair outside the home then Medicare won't cover the power wheelchair.
Medicare will also not replace a wheelchair that you recently received or started renting if you're simply not happy with it.
If you think you need a power wheelchair or scooter, you should first speak to your doctor or primary care provider (PCP).
If your doctor or PCP determines that it is medically necessary that you use a power wheelchair or scooter, they should sign an order, prescription, or certificate after a face-to-face office visit.