Does Medicare cover Electric Wheelchairs?

Medicare Part B provide coverage for Durable Medical Equipment (DME) such as power-operated vehicles (scooters), walkers, and wheelchairs.

To qualify for this coverage, certain criteria must be met:

• A physician or provider treating patients’ medical condition must submit a written order or prescription and confirm your need for a wheelchair or scooter for home use.

• You must have limited mobility and fulfill all the following conditions:
  • patient experiencing significant difficulty in moving around your home due to a health issues or conditions.
  • Patient unable to perform daily living activities like bathing, dressing, getting in or out of a bed or chair, or using the bathroom, even with the help of a cane, crutch, or walker.
  • Capable of safely operating and getting on and off the wheelchair or scooter, or have someone available to assist you in using the device safely.
  • Both the provider treating patient and the equipment supplier must accept Medicare.
  • Your provider or supplier has ensured that the equipment can be used in your home, considering space and accessibility.

Medicare Coverage on DME:

• Patient is responsible for 20% of the Medicare-approved amount after yearly Part B deductible is met.
• Medicare covers the remaining 80%.

If you are enrolled in a Medicare Advantage Plan, it’s important to contact your plan to understand the costs and approved Durable Medical Equipment (DME) suppliers.

Table of Contents

• Types of Wheelchairs as DME
• Prior Authorization of Certain Equipment
• Power/Electric Wheelchairs that Require Prior Authorization
• How will I know if my prior authorization request is approved?
• Why was my request denied?
• What do I do if I suspect fraud?
• Are Electric Wheelchairs allowed in Nursing Homes?
• 10 Best Electric Wheelchairs on Amazon
• Are electric wheelchairs allowed on planes?
• Related Articles:

Types of Wheelchairs as DME

• Manual Wheelchair:
  • Suitable if you cannot safely use a cane or walker but have sufficient upper body strength or someone to assist you.
  • Initially, you may be required to rent the wheelchair before purchasing it.
• Power-Operated Vehicle/Scooter:
  • Appropriate if you’re unable to use a cane, walker, or manual wheelchair.
  • You must be able to safely enter and exit the scooter and have the strength to sit upright and operate the controls.
  • If a scooter is not needed for long-term use, renting is an option. Discuss this with your supplier.
• Power Wheelchair:
  • If using a manual wheelchair at home is not feasible, or if you don’t qualify for a scooter, you may be eligible for a power wheelchair.
• Important Note:
  • Before receiving either a power wheelchair or scooter, a face-to-face examination with your doctor is mandatory.
  • During this exam, the doctor will assess your needs and determine if you can safely operate the device.
  • Following the assessment, the doctor will provide a written order to Medicare, detailing your need for the device and your capability to operate it safely.

Prior Authorization of Certain Equipment

You may need “prior authorization” for certain types of equipment. If so, your  durable medical equipment (DME) supplier will need to:

• To obtain certain types of power wheelchairs through Medicare, a “prior authorization” process is necessary:

• Prior Authorization Process:
  • This involves sending “prior authorization” documents to Medicare, along with the request for the power wheelchair.
  • You have the option to submit the request yourself. To do this, you need to obtain the necessary documents from both your doctor and the Durable Medical Equipment (DME) supplier.
• Medicare’s Review:
  • Once submitted, Medicare will review the provided information to confirm your eligibility and ensure you meet all the criteria for the requested item.
• Coverage and Timeliness:
  • It’s important to note that your Medicare coverage and benefits remain unchanged under this program.
  • This process should not cause any significant delays in receiving the equipment you need.

Power/Electric Wheelchairs that Require Prior Authorization

The listed below power wheelchairs require “prior authorization” before Medicare will pay for them:

Model	Group Type	Duty	Seat Type	Weight Capacity (lbs)
K0813	1	standard	Sling/solid seat/back	300
K0815	1	standard	Sling/solid seat/back	300
K0820	2	standard	Sling/solid seat/back	300
K0822	2	standard	Sling/solid seat/back	300
K0824	2	heavy duty	Sling/solid seat/back	601 or more
K0826	2	very heavy duty	Sling/solid seat/back	301 to 450
K0828	2	extra heavy duty	Sling/solid seat/back	451 to 600
K0835	2	standard	Sling/solid seat/back	601 or more
K0837	2	heavy duty	Sling/solid seat/back	301 to 450
K0839	2	very heavy duty	Sling/solid seat/back	451 to 600
K0840	2	extra heavy duty	Sling/solid seat/back	601 or more
K0841	2	standard	Sling/solid seat/back	301 to 450
K0843	2	heavy duty	Sling/solid seat/back	451 to 600
K0848	3	standard	Sling/solid seat/back	601 or more
K0850	3	heavy duty	Sling/solid seat/back	301 to 450
K0852	3	very heavy duty	Sling/solid seat/back	451 to 600
K0854	3	extra heavy duty	Sling/solid seat/back	601 or more
K0856	3	standard	Sling/solid seat/back	301 to 450
K0858	3	heavy duty	Sling/solid seat/back	451 to 600
K0860	3	very heavy duty	Sling/solid seat/back	601 or more
K0861	3	standard	Sling/solid seat/back	301 to 450
K0862	3	heavy duty	Sling/solid seat/back	451 to 600
K0863	3	very heavy duty	Sling/solid seat/back	601 or more
K0864	3	extra heavy duty	Sling/solid seat/back	301 to 450
K0814	1	standard	Portable	300
K0816	2	standard	Not portable	300
K0821	2	standard	Portable	300
K0823	2	standard	Not portable	300
K0825	2	heavy duty	Portable	601 or more
K0827	2	very heavy duty	Not portable	301 to 450
K0829	2	extra heavy duty	Portable	451 to 600
K0836	2	standard	Not portable	601 or more
K0838	2	heavy duty	Portable	301 to 450
K0842	2	standard	Not portable	451 to 600
K0849	3	standard	Portable	601 or more
K0851	3	heavy duty	Not portable	301 to 450
K0853	3	very heavy duty	Portable	451 to 600
K0855	3	extra heavy duty	Not portable	601 or more
K0857	3	standard	Portable	301 to 450
K0859	3	heavy duty	Not portable	451 to 600
K0800	1	standard	300	300
K0801	1	heavy duty	300	300
K0802	1	very heavy duty	300	300
K0806	2	standard	300	301 to 450
K0807	2	heavy duty	300	451 to 600
K0808	2	very heavy duty	300	301 to 450

Also Read : What is Pre Authorization in Medical Billing?

How will I know if my prior authorization request is approved?

Medicare will send a decision letter to the power wheelchair supplier of patient.  You can directly contact your power wheelchair supplier about the decision, or call on below mentioned numbers

1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Also Read : Does Medicare cover the RSV vaccine?

Why was my request denied?

Your prior-authorization request may be denied if:

• Medicare finds patient don’t medically need a power wheelchair.

• Medicare doesn’t get all the information required to make a decision. If more information is needed, your DME supplier may resubmit “prior authorization” request.

Also Read : Explanation of Benefit Codes | EOB Codes List

What do I do if I suspect fraud?

You can help Medicare stop fraud and abuse by:

• Always Keep a record of your doctor’s appointments and any equipment you get.

• Review “Medicare Summary Notices” (MSNs) for payment of claims for equipment you never got or no longer have Signs of fraud and abuse by a supplier are offers to:

• Give you a “free” wheelchair or scooter

• Pay you cash or waive your copayment

• Have a doctor you don’t know order a wheelchair or scooter for you

For more information,

visit Medicare.gov or call 1-800-MEDICARE

(1-800-633-4227). TTY users can call 1-877-486-2048.

If you want to report possible fraud, visit Medicare Official Website for Fraud and Abuse

Are Electric Wheelchairs allowed in Nursing Homes?

There is certain rule for using Electric Wheelchairs in Nursing Homes and summary of that rule is as under mentioned. The Pdf copy of that rule is also attached.

Summary of Provider Letter 15-08: Power Mobility Device Considerations

The Department of Aging and Disability Services (Feb 26, 2015) {COMMISSIONER
Jon Weizenbaum }

Policy Overview:

• The letter addresses the use of power mobility devices (like power wheelchairs and scooters) in Nursing Facilities (NFs).
• NFs must inform residents and their kin/guardian about rights and rules in understandable language.
• NFs admitting residents with power mobility devices must have specific policies for their use.

Resident Rights:

• NFs, especially Medicaid certified ones, must not discriminate based on disability.
• Facilities must adhere to federal and state regulations concerning nondiscrimination.
• Rights include the resident’s ability to exercise their rights both at the facility and as a U.S. citizen or resident.
• Discrimination or denial of appropriate care based on disability is not permitted.

Balance and Safety Concerns:

• Power mobility devices enhance mental and psychosocial well-being but can pose safety risks.
• NFs must have policies to ensure the safety and well-being of all residents concerning these devices.
• Assessment, documentation, and care planning for each resident’s need for a power mobility device are required.
• If safety concerns arise with a resident’s use of a device, reassessment and intervention are necessary.

Evaluate Supervision and Interventions:

• Possible interventions include retraining, re-educating about safety, adjusting the environment, and fall intervention supervision.
• The resident’s care plan should reflect these interventions.

Life Safety Code Compliance:

• NFs should facilitate the transport of power mobility devices for residents’ appointments.
• Residents should be allowed to store devices in their rooms unless it violates Life Safety Codes.
• Staff must mediate any disputes over device storage in shared rooms.
• Charging areas for these devices must be safe, well-ventilated, and not obstructive.
• NFs must manage hazards related to battery types and charging, adhering to OSHA standards.

Exclusions and Contact Information:

• This letter does not apply to custom manual wheelchairs for Preadmission Screening and Resident Review (PASRR) eligible residents.
• Contact information is provided for queries regarding Life Safety Code and the content of the letter.

Please save below power Mobility Device Rule Pdf,

Provider Letter 15-08 – Power Mobility Device Considerations Pdf

10 Best Electric Wheelchairs on Amazon

Are electric wheelchairs allowed on planes?

The airline might have to detach the battery and package it separately in cases where the wheelchair cannot be stored upright in the cargo area. Although wheelchairs and other mobility aids are allowed through the security checkpoint, they are not permitted inside the aircraft cabin.

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