Medicare's Coverage Critieria for Wheelchair
- Patient medical condition limits mobility or significantly impairs mobility-related activities of daily living (MRADL: Toileting, Bathing, Feeding, Dressing, Grooming, etc.) *Identify underlying conditions causing mobility limitation, what specific MRADL is impaired and how
- HOW:
- Prevents patient from accomplishing MRADL entirely, OR
- Places patient at reasonably determined heightened risk of morbidity/mortality secondary to attempts to perform an MRADL, OR
- Prevents pt from completing MRADL within reasonable time frame
- Patient’s mobility limitation cannot be resolved with use of Cane or Walker (Explain why)
- Patient’s living space provides adequate access between rooms, maneuvering space and surface for use of WC (Use in your own words)
- Use of WC will significantly improve ability to perform MRADLs and patient will use it on a regular basis in living space (Provide specific activities that will be possible, must mention use in home)
- Patient has not expressed unwillingness to use manual WC in home (Patient must be willing to use)
AND
Patient has sufficient upper extremity function/other physical or mental capabilities needed to safely self propel in home, daily (Limitations of strength, endurance, range of motion, coordination, presence of pain, deformity or absence of one/or both upper extremities are relevant to assessment of upper extremity function)
OR
Patient has caregiver who is available, willing and able to provide assistance with WC (who is caregiver, how often available)
Lightweight wheelchair: Cannot self propel in standard wc and can/does self propel in lw chair (Does not apply if reliance on caregiver)
Hemi height wheelchair: requires a lower seat height of 17” or 18” because: short stature or need to place feet on ground
Heavy duty wheelchair: patient weighs over 250lbs (documented weight listed in chart notes)