Power Wheelchair

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Power/Motorized Wheelchairs








A powered wheelchair may be covered if:


  • The beneficiary has a mobility limitation that significantly impairs his/her abilities to participate in one or more Mobility Related Activities of Daily Living (MRADL’s) in the home (toileting, feeding, dressing, grooming and bathing).


  • The beneficiary/caregiver is able to use the equipment safely.


  • A cane/walker is not sufficient and the beneficiary is unable to self-propel a manual wheelchair.


  • The home environment must be able to support the use of the equipment.


Documentation Required:


  • A written order from the treating physician within 45 days of a face to face exam.  The written order must include:
    • Beneficiary’s name
    • Description of item ordered -  power mobility device
    • Date of the face to face exam
    • Pertinent diagnoses/conditions that relate to the need for the power mobility device
    • Length of need
    • Physician signature and date


  • Copy of chart notes from physician which documents:
    • Symptoms
    • Related Diagnoses
    • History – how long the condition has been present, the progression, past interventions that have been tried and past use of any mobility devices
    • Physical Evaluation -  weight, impairment of strength/range of motion/coordination of limbs, presence of abnormal tone/deformity, neck/trunk/pelvic flexibility, and sitting and standing balance
    • Functional Assessment -  any problems with the need for assistance to transfer between a bed and equipment or walking around the home (including distance/speed/balance)
    • How/why the beneficiary cannot use a cane/walker or manual wheelchair and why it is unsafe


  • An Assessment by a physical or occupational therapist for certain power wheelchairs is required.  This must be added to the physician’s chart notes.


  • A Detailed Order will be sent to the physician for his final approval after all equipment needs are evaluated.


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