Coverage Criteria and Documentation Requirements for Power Mobility Devices (Power Wheelchairs and Scooters)

Medicare has changed the coverage criteria and documentation requirements for Power Mobility Devices (PMD) for dates of service (date of delivery) on or after May 5, 2005. Power Mobility Devices include power wheelchairs and scooters/power operated vehicles (POV). If you are considering prescribing a Power Mobility Device please review the following information as it will assist you in understanding how these changes have affected the prescription and funding process with Medicare.

"NEW" Coverage Criteria for PMDs - National Coverage Determination (NCD)

• Medicare has modernized the policy and replaced the "Bed or Chair Confined" requirement with consideration now given to the beneficiary's ability to safely and in a reasonable time frame participate in one or more Mobility Related Activities of Daily Living (MRADLs).
  
  
• MRADLs include - Dressing, grooming, toileting, bathing and eating (including Assisted Living Facilities) in customary locations within the home.

Medicare’s coverage policy for PMD’s .

The following tools are available for physicians and physician office staff to help understand Medicare’s coverage policy for PMD’s and how to accurately prescribe and justify the appropriate PMD for your patient:

• Medicare Physician Resource Guide : Provides guidance to physicians that outlines the current coverage policy for PMDs (9 step algorithm), the face-to-face exam requirement, PMD prescription requirements, and what to include in your supporting documentation/information.

• "Choosing the Right Power Mobility Solution for your Patients" : Provides guidance to physicians in determining which Power Mobility Device is appropriate based on a patient's condition, an assessment of the patient's living environment, and functionality of the mobility device.

• PMD Prescription : A sample prescription form that contains all the necessary elements that are required on a prescription per the Interim Final Rule/Local Coverage Determination policy.

This 1-hour session will provide physicians and office staff with a good understanding of what Medicare is requiring to authorize payment for a Power Mobility Device (PMD).This session is geared toward clinicians and will outline their responsibility to ensure funding for a PMD for qualified patients. Learn how to properly document the medical necessity for Power Mobility Devices (Scooters and Power Wheelchairs) for your Medicare patients.

Click here for detailed information on our 2006 session, including dates, locations, and how to register .

For more information contact a member of Pride's Reimbursement Team at 1-800-800-8586.