People who have become disabled and can no longer walk, or cannot walk without difficulty, may benefit from a mobility scooter or powerchair. Although TV commercials suggest that the process is fast and painless, your healthcare provider will fill out paperwork that will help you to receive a scooter or power chair at little or no cost, many disabled individuals and their caregivers find out that the process can be much more difficult. The authorization process sometimes requires several trips to a healthcare provider or specialist and conforming to complex Medicare rules.
A personal mobility device (PMD) is covered by Medicare only if three criteria are met:
- The patient is unable to participate in Mobility-Related Activities of Daily Living (MRADLs) like going to the bathroom, feeding, or dressing.
- A cane or walker is not enough to safely and sufficiently help.
- The patient does not have the upper body strength or ability to use a standard wheelchair
Healthcare Provider Requirements
Healthcare providers bear the burden of prescribing a mobility scooter or powerchair to disabled people 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 healthcare provider requirements by the Centers for Medicare & Medicaid Services include:
- 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, that will be sent to the supplier—plus any additional medical documentation, if necessary, to support the request for a PMD. The paperwork must be sent to the PMD supplier within 45 days of the face-to-face examination.
- A bill for an appropriate evaluation-and-management code for the face-to-face examination and subsequent bills with appropriate codes to charge for the additional time required to provide the examination and documentation to the supplier of the PMD.
Assessment of Your Medical Needs
You must address specific questions in your face-to-face interview with a healthcare provider. Specifically, you or your caregiver must answer:
- What is your mobility challenge and how does it interfere with your daily activities?
- Why can’t a cane or walker handle your mobility needs?
- Why can’t a manual wheelchair be used to meet your mobility needs?
- Are you capable of transferring to and from the PMD and operating it safely within your home?
- Do you have the physical and mental capacity to operate the PMD by yourself?
Some people might benefit from PMDs but do not meet the strict medical necessity guidelines to obtain one through Medicare.
There is no restriction on buying a mobility scooter or power chair from a supplier if you want to purchase it out-of-pocket with no insurance support. Several suppliers both nationally and locally (usually nearby to hospitals and nursing homes) will sell PMDs to anyone and some retailers 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 classified ads as well as other similar local ads online.